Provider Demographics
NPI:1427168624
Name:OWADA, CARL YASUTOSHI (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:YASUTOSHI
Last Name:OWADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:116 S PALISADE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8904
Mailing Address - Country:US
Mailing Address - Phone:805-739-3280
Mailing Address - Fax:805-739-3380
Practice Address - Street 1:116 S PALISADE DR STE 103
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8904
Practice Address - Country:US
Practice Address - Phone:805-739-3280
Practice Address - Fax:805-739-3380
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG718922080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF53602Medicare UPIN
CA00G718920Medicare ID - Type Unspecified