Individual
REBECCA H. KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPED
Contact information
Practice address
5011 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1350
(505) 872-3668
(505) 888-7041
Mailing address
6712 CHRISTY AVE NE, ALBUQUERQUE, NM 87109-4000
(505) 610-9250
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
10852
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05756863
—
NM
01
—
NM00TA40
BC BS NEW MEXICO
NM
Enumeration date
02/09/2006
Last updated
03/31/2008
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