| 505 Diagnostics Llc | |
|
4225 Montgomery Blvd Ne Albuquerque NM 87109-1103 | |
| (505) 361-1931 | |
| (505) 521-5147 |
| Full Name | 505 Diagnostics Llc |
|---|---|
| Speciality | Psychologist |
| Location | 4225 Montgomery Blvd Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Rebekah Jan Hutchins Khan (CEO/PROVIDER) |
| Authorized Official Contact | 4707289352 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 505 Diagnostics Llc 4225 Montgomery Blvd Ne Albuquerque NM 87109-1103 Ph: (505) 548-8035 | 505 Diagnostics Llc 4225 Montgomery Blvd Ne Albuquerque NM 87109-1103 Ph: (505) 361-1931 |
| NPI Number | 1629810486 |
|---|---|
| Provider Enumeration Date | 06/11/2024 |
| Last Update Date | 02/04/2025 |
| Certification Date | 02/04/2025 |
| Medicare PECOS PAC ID | 6709317316 |
|---|---|
| Medicare Enrollment ID | O20241008000079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629810486 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Rebekah Jan Hutchins Khan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740927953 PECOS PAC ID: 8123476785 Enrollment ID: I20231121001872 |
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