Healthcare Provider Details

I. General information

NPI: 1558739219
Provider Name (Legal Business Name): NICOLE MONTOYA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 INDIANA AVE STE 100
RIVERSIDE CA
92506-4221
US

IV. Provider business mailing address

6809 INDIANA AVE STE 100
RIVERSIDE CA
92506-4221
US

V. Phone/Fax

Practice location:
  • Phone: 909-731-8179
  • Fax:
Mailing address:
  • Phone: 951-899-0718
  • Fax: 951-268-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY35670
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: