Healthcare Provider Details

I. General information

NPI: 1639523855
Provider Name (Legal Business Name): ROBERTO CARLOS MONTES PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT C MONTES PSY. D.

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 10/23/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 B VETERANS BLVD
ACOMA NM
87034
US

IV. Provider business mailing address

129 MEDICINE HORSE DR
TO'HAJIILEE NM
87026
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5300
  • Fax: 505-552-5490
Mailing address:
  • Phone: 505-908-2307
  • Fax: 505-908-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34858
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: