| Barbara Koltuska, Ph.d., P.c. | |
|
11927 Menaul Blvd Ne Ste 107 Albuquerque NM 87112-2457 | |
| (505) 292-5003 | |
| (505) 292-5003 |
| Full Name | Barbara Koltuska, Ph.d., P.c. |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 11927 Menaul Blvd Ne Ste 107, Albuquerque, New Mexico |
| Authorized Official Name and Position | Barbara Koltuska-haskin (PRESIDENT) |
| Authorized Official Contact | 5052925003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Barbara Koltuska, Ph.d., P.c. 11927 Menaul Blvd Ne Ste 107 Albuquerque NM 87112-2457 Ph: (505) 292-5003 | Barbara Koltuska, Ph.d., P.c. 11927 Menaul Blvd Ne Ste 107 Albuquerque NM 87112-2457 Ph: (505) 292-5003 |
| NPI Number | 1477611341 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5597766410 |
|---|---|
| Medicare Enrollment ID | O20070119000419 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477611341 | NPI | - | NPPES |
| N5851 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 580 (New Mexico) | Primary |
| Provider Name | Barbara Koltuska |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1114070794 PECOS PAC ID: 1052312972 Enrollment ID: I20070119000411 |
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