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General NPI Number Information
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NPI Number | 1134192008
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Entity Type | Individual
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Provider Name | REBECCA H. KOONTZ CPED
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Gender | Female
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 5011 MONTGOMERY BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1350
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Country | US
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Telephone | 505-872-3668
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Fax | 505-888-7041
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Provider Business Mailing Address
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Address Line | 6712 CHRISTY AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4000
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Country | US
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Telephone | 505-610-9250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | 10852
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License Number State | NM
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