Healthcare Provider Details

I. General information

NPI: 1346973484
Provider Name (Legal Business Name): HERMAN MONTOYA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 OSUNA RD NE STE 2D
ALBUQUERQUE NM
87111-2069
US

IV. Provider business mailing address

500 SW 7TH ST STEA205
RENTON WA
98057
US

V. Phone/Fax

Practice location:
  • Phone: 877-522-1275
  • Fax: 833-888-7145
Mailing address:
  • Phone: 877-522-1275
  • Fax: 833-888-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2023-0292
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2023-0292
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: