Individual
REBECCA SUSANA MOORE-KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2600 MARBLE AVE NE, BLDG 2, ALBUQUERQUE, NM 87106-2058
(505) 272-2190
(505) 272-3466
Mailing address
933 BRADBURY DR SE, ALBUQUERQUE, NM 87106-4374
(505) 272-3120
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Enumeration date
07/27/2012
Last updated
05/07/2014
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