Healthcare Provider Details

I. General information

NPI: 1134600042
Provider Name (Legal Business Name): TAMARA OWEN PMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FORTUNA RD NW
ALBUQUERQUE NM
87121-1306
US

IV. Provider business mailing address

6400 UPTOWN BLVD NE STE 360
ALBUQUERQUE NM
87110-4202
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-6993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberX-10535
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: