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General NPI Number Information
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NPI Number | 1700251824
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Entity Type | Organization
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Legal Business Name | HEATHER OWENS LLC
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 4181 CAMINO COYOTE
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City | LAS CRUCES
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State | NM
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Zip | 88011-7096
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Country | US
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Telephone | 575-532-6006
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Fax | 575-932-9049
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Provider Business Mailing Address
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Address Line | 4181 CAMINO COYOTE
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City | LAS CRUCES
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State | NM
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Zip | 88011-7096
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Country | US
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Telephone | 575-532-6006
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Fax | 575-932-9049
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Authorized Official
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Title or Position | PRESIDENT
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Name | HEATHER OWENS
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Credential | MD
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Telephone | 707-227-6467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD2015-0823
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License Number State | NM
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