Healthcare Provider Details

I. General information

NPI: 1881034544
Provider Name (Legal Business Name): MR. SALOMON MONTANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 CAMINO DEL SOL NE
ALBUQUERQUE NM
87111-1418
US

IV. Provider business mailing address

PO BOX 16112
ALBUQUERQUE NM
87191-1612
US

V. Phone/Fax

Practice location:
  • Phone: 505-798-9919
  • Fax: 505-798-9919
Mailing address:
  • Phone: 505-798-9919
  • Fax: 505-798-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number251E00000X
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: