Healthcare Provider Details

I. General information

NPI: 1245925940
Provider Name (Legal Business Name): TIERRA ALTA NEUROPSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 5TH ST STE 206
SANTA FE NM
87505-5403
US

IV. Provider business mailing address

1911 5TH ST STE 206
SANTA FE NM
87505-5403
US

V. Phone/Fax

Practice location:
  • Phone: 505-695-5675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MONZONES
Title or Position: OWNER AND CLINICAL NEUROPSYCHOLOGIS
Credential:
Phone: 917-805-7945