Provider Demographics
NPI:1003789322
Name:OTTO, RANDY KURT (PHD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:KURT
Last Name:OTTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIV OF NEW MEXICO
Mailing Address - Street 2:DEPT OF PSYCHIATRY & BEHAVIORAL SCIENCES MSCO9 5030
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:813-300-1484
Mailing Address - Fax:
Practice Address - Street 1:FAMILY MEDICINE CENTER
Practice Address - Street 2:2400 TUCKER AVE NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPSY-2025-0065103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic