MEDICARE: BARBARA KOLTUSKA, PH.D., P.C.

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	103G00000X	Clinical Neuropsychologist	580	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477611341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARBARA KOLTUSKA, PH.D., P.C.

Provider Business Mailing Address
First Line	:	11927 MENAUL BLVD NE STE 107
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-2457
Country	:	US
Telephone Number	:	505-292-5003
Fax Number	:	505-292-5003

Provider Business Practice Location Address
First Line	:	11927 MENAUL BLVD NE STE 107
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-2457
Country	:	US
Telephone Number	:	505-292-5003
Fax Number	:	505-292-5003

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARBARA KOLTUSKA-HASKIN
Credential	:	PH.D.
Telephone Number	:	505-292-5003

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	08/22/2020

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