Provider Demographics
NPI:1629810486
Name:505 DIAGNOSTICS LLC
Entity type:Organization
Organization Name:505 DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:HUTCHINS KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-728-9352
Mailing Address - Street 1:4225 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1103
Mailing Address - Country:US
Mailing Address - Phone:505-548-8035
Mailing Address - Fax:505-581-3291
Practice Address - Street 1:4225 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1103
Practice Address - Country:US
Practice Address - Phone:505-361-1931
Practice Address - Fax:505-521-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty