MEDICARE: KOFI BOATENG

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	106S00000X	Behavior Technician		NM

General Provider Information

NPI Number	:	1306701115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOFI BOATENG

Provider Business Mailing Address
First Line	:	1801 GIBSON BLVD SE APT 1014
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-3349
Country	:	US
Telephone Number	:	505-677-6749
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 RENARD PL SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4258
Country	:	US
Telephone Number	:	505-230-3790
Fax Number	:

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

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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Directions to “ KOFI BOATENG ” Practice Location

Language	Start Address	Practice Location

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