MEDICARE: HOLLY RAY KASTENDIECK MD

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
1	390200000X	Student in an Organized Health Care Education/Training Program		NM

General Provider Information

NPI Number	:	1740078260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY RAY KASTENDIECK MD

Provider Business Mailing Address
First Line	:	MSC09 5040 1 UNIVERSITY OF NEW MEXICO
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-1178
Country	:	US
Telephone Number	:	505-272-6607
Fax Number	:	505-272-8045

Provider Business Practice Location Address
First Line	:	MSC09 5040 1 UNIVERSITY OF NEW MEXICO
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-1178
Country	:	US
Telephone Number	:	505-272-6607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2025
Last Update Date	:	04/25/2025

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