Healthcare Provider Details

I. General information

NPI: 1255252987
Provider Name (Legal Business Name): AUBRIANA YOUNG
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18648 C PRIVATE DR
ESPANOLA NM
87532
US

IV. Provider business mailing address

PO BOX 23883
SANTA FE NM
87502-3883
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-7576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0257
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: