Healthcare Provider Details

I. General information

NPI: 1639927817
Provider Name (Legal Business Name): CARRA MONTIJO PNP/FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 N HILLRIDGE
MESA AZ
85207-4923
US

IV. Provider business mailing address

841 N HILLRIDGE
MESA AZ
85207-4923
US

V. Phone/Fax

Practice location:
  • Phone: 602-315-2362
  • Fax:
Mailing address:
  • Phone: 602-315-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number282792
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number282792
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: