Healthcare Provider Details

I. General information

NPI: 1447851845
Provider Name (Legal Business Name): JESSICA MONTOYA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CALIFORNIA PINE RD NE
RIO RANCHO NM
87124-2505
US

IV. Provider business mailing address

119 CALIFORNIA PINE RD NE
RIO RANCHO NM
87124-2505
US

V. Phone/Fax

Practice location:
  • Phone: 505-730-9000
  • Fax:
Mailing address:
  • Phone: 505-730-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61336
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: