Healthcare Provider Details

I. General information

NPI: 1073108676
Provider Name (Legal Business Name): LAURA A MONTOYA HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 GALISTEO ST STE 1A
SANTA FE NM
87505-4752
US

IV. Provider business mailing address

405 VILLA VERDE DR SE
RIO RANCHO NM
87124-1395
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-4327
  • Fax: 505-988-4327
Mailing address:
  • Phone: 505-730-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD0946
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: