Healthcare Provider Details

I. General information

NPI: 1588780548
Provider Name (Legal Business Name): KARLA KOCH ND, DOM, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 ANDERSON AVE SE
ALBUQUERQUE NM
87106-1612
US

IV. Provider business mailing address

4701 PERSHING AVE SE
ALBUQUERQUE NM
87108-3437
US

V. Phone/Fax

Practice location:
  • Phone: 505-573-4325
  • Fax: 505-404-0875
Mailing address:
  • Phone: 505-573-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR48340
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number867
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number10
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: