Provider Demographics
NPI:1699943340
Name:OWENS, CLINTON ONYX (BA CM)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:ONYX
Last Name:OWENS
Suffix:
Gender:M
Credentials:BA CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1610
Mailing Address - Country:US
Mailing Address - Phone:415-682-3250
Mailing Address - Fax:
Practice Address - Street 1:101 15TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-5103
Practice Address - Country:US
Practice Address - Phone:415-865-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator