Provider Demographics
NPI:1427501089
Name:OWENS, SHIRLEY J (PA-C)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:J
Last Name:OWENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 WILSHIRE BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1112
Mailing Address - Country:US
Mailing Address - Phone:213-368-1654
Mailing Address - Fax:213-368-1658
Practice Address - Street 1:2975 WILSHIRE BLVD
Practice Address - Street 2:#401
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1107
Practice Address - Country:US
Practice Address - Phone:919-358-7600
Practice Address - Fax:213-368-1658
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10570363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical