Healthcare Provider Details

I. General information

NPI: 1073229696
Provider Name (Legal Business Name): ALICIA SOPHIA MONTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N THORNTON ST STE H
CLOVIS NM
88101-5508
US

IV. Provider business mailing address

1200 N THORNTON ST STE H
CLOVIS NM
88101-5508
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-4411
  • Fax:
Mailing address:
  • Phone: 575-935-4411
  • Fax: 575-935-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: