Provider Demographics
NPI:1588780548
Name:KOCH, KARLA (ND, DOM, RN)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:ND, DOM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 PERSHING AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3437
Mailing Address - Country:US
Mailing Address - Phone:505-573-4325
Mailing Address - Fax:
Practice Address - Street 1:3536 ANDERSON AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1612
Practice Address - Country:US
Practice Address - Phone:505-573-4325
Practice Address - Fax:505-404-0875
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR48340163WG0000X
NM867171100000X
NM10175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No171100000XOther Service ProvidersAcupuncturist