Healthcare Provider Details

I. General information

NPI: 1548277403
Provider Name (Legal Business Name): SYLVIA M MONTOYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 JAMES CANYON HIGHWAY
CLOUDCROFT NM
88317
US

IV. Provider business mailing address

223 S REYMOND ST
LAS CRUCES NM
88005-2622
US

V. Phone/Fax

Practice location:
  • Phone: 505-682-2542
  • Fax: 505-682-3075
Mailing address:
  • Phone: 505-647-1376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNM 90-255
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: