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NPI Code Detail

MEDICARE: AASTHA GAUTAM MA

MEDICARE: AASTHA GAUTAM MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorCTB-2024-0795NM

General Provider Information

NPI Number : 1679117667
Entity Type Code : Individual
Provider Name (Legal Business Name) : AASTHA GAUTAM MA
Provider Business Mailing Address
First Line : 6300 RIVERSIDE PLAZA LN NW STE 100
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-1908
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6300 RIVERSIDE PLAZA LN NW STE 100
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-1908
Country : US
Telephone Number : 860-983-8857
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2019
Last Update Date : 03/21/2025

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Directions to “ AASTHA GAUTAM MA” Practice Location

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