Healthcare Provider Details

I. General information

NPI: 1720621006
Provider Name (Legal Business Name): MONICA MARIE MONTANO FIRST ASSIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2019
Last Update Date: 10/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10909 WOODLAND AVE NE
ALBUQUERQUE NM
87112-1680
US

IV. Provider business mailing address

10909 WOODLAND AVE NE
ALBUQUERQUE NM
87112-1680
US

V. Phone/Fax

Practice location:
  • Phone: 505-933-2547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: