Healthcare Provider Details

I. General information

NPI: 1992361786
Provider Name (Legal Business Name): LESLIE J HIGUITA MONTOYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 WAKE FOREST RD STE 310
RALEIGH NC
27609-7376
US

IV. Provider business mailing address

3480 WAKE FOREST RD STE 310
RALEIGH NC
27609-7376
US

V. Phone/Fax

Practice location:
  • Phone: 919-862-5620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number2024-01997
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: