Healthcare Provider Details

I. General information

NPI: 1730033366
Provider Name (Legal Business Name): PRESTON JULIETTE OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 LUISA ST STE 8
SANTA FE NM
87505-4175
US

IV. Provider business mailing address

1330 ACEQUIA BORRADA
SANTA FE NM
87507-3071
US

V. Phone/Fax

Practice location:
  • Phone: 502-681-8281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2024-0044
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: