Healthcare Provider Details

I. General information

NPI: 1255965992
Provider Name (Legal Business Name): KIRSTEIN M MONTOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 E US HIGHWAY 66
EL RENO OK
73036-9125
US

IV. Provider business mailing address

7777 E US HIGHWAY 66
EL RENO OK
73036-9125
US

V. Phone/Fax

Practice location:
  • Phone: 405-422-8800
  • Fax: 405-422-8818
Mailing address:
  • Phone: 405-422-8800
  • Fax: 405-422-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberK8D7D5Y9
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: