Healthcare Provider Details

I. General information

NPI: 1285852418
Provider Name (Legal Business Name): ANGELINA MONTOYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63360 BRITTA ST, BLDG 1
BEND OR
97701
US

IV. Provider business mailing address

63360 BRITTA ST, BLDG 1
BEND OR
97701
US

V. Phone/Fax

Practice location:
  • Phone: 541-318-4845
  • Fax: 541-318-5156
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD26047
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: