Provider Demographics
NPI:1871269076
Name:KAUTIAINEN, RELLA
Entity Type:Individual
Prefix:
First Name:RELLA
Middle Name:
Last Name:KAUTIAINEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF NEW MEXICO
Mailing Address - Street 2:DEPT OF PSYCHIATRY & BEHAVIORAL SCIENCES MSC09-5030
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131
Mailing Address - Country:US
Mailing Address - Phone:505-272-5428
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:DEPT OF PSYCHIATRY & BEHAVIORAL SCIENCES MSC09-5030
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-272-5428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program