Healthcare Provider Details

I. General information

NPI: 1700251824
Provider Name (Legal Business Name): HEATHER OWENS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4181 CAMINO COYOTE
LAS CRUCES NM
88011-7096
US

IV. Provider business mailing address

4181 CAMINO COYOTE
LAS CRUCES NM
88011-7096
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-6006
  • Fax: 575-932-9049
Mailing address:
  • Phone: 575-532-6006
  • Fax: 575-932-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2015-0823
License Number StateNM

VIII. Authorized Official

Name: HEATHER OWENS
Title or Position: PRESIDENT
Credential: MD
Phone: 707-227-6467