Healthcare Provider Details

I. General information

NPI: 1215100540
Provider Name (Legal Business Name): YVONNE M. MONTES CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SIPAPU ST BOX 6952
TAOS NM
87571-6489
US

IV. Provider business mailing address

PO BOX 956
QUESTA NM
87556-0956
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-5857
  • Fax: 575-758-2832
Mailing address:
  • Phone: 575-586-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: