Healthcare Provider Details

I. General information

NPI: 1659853570
Provider Name (Legal Business Name): SELENA OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 BLUE OAKS BLVD STE 260
ROSEVILLE CA
95747-4003
US

IV. Provider business mailing address

1430 BLUE OAKS BLVD STE 260
ROSEVILLE CA
95747-4003
US

V. Phone/Fax

Practice location:
  • Phone: 530-887-1006
  • Fax:
Mailing address:
  • Phone: 530-887-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-BYNFAC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: