Healthcare Provider Details

I. General information

NPI: 1013798321
Provider Name (Legal Business Name): ANGELICA MARIA MONTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL NE STE E1
ALBUQUERQUE NM
87102-2645
US

IV. Provider business mailing address

801 ENCINO PL NE STE E1
ALBUQUERQUE NM
87102-2645
US

V. Phone/Fax

Practice location:
  • Phone: 505-489-8845
  • Fax:
Mailing address:
  • Phone: 505-489-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: