MEDICARE: KAYLA HOLOVACH

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	2081P0010X	Pediatric Rehabilitation Medicine Physician	PT-2023-2065	NM

General Provider Information

NPI Number	:	1821942194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA HOLOVACH

Provider Business Mailing Address
First Line	:	1589 VALLE DE COLORES ST NW
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-9158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1589 VALLE DE COLORES ST NW
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-9158
Country	:	US
Telephone Number	:	505-259-2657
Fax Number	:

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

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/24/2026

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Directions to “ KAYLA HOLOVACH ” Practice Location

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