Provider Demographics
NPI:1912460569
Name:OWENS, JESSICA ANN (RT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:OWENS
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2055
Mailing Address - Country:US
Mailing Address - Phone:831-576-3000
Mailing Address - Fax:831-713-5398
Practice Address - Street 1:3601 CALDWELL DR
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2055
Practice Address - Country:US
Practice Address - Phone:831-576-3000
Practice Address - Fax:831-713-5398
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565132247100000X, 2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist