Healthcare Provider Details

I. General information

NPI: 1639982150
Provider Name (Legal Business Name): SANDRA MONTOYA CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 VIKING DR STE E
VIRGINIA BEACH VA
23452-7323
US

IV. Provider business mailing address

500 WINSTON SALEM AVE APT 104
VIRGINIA BEACH VA
23451-4784
US

V. Phone/Fax

Practice location:
  • Phone: 757-275-8050
  • Fax:
Mailing address:
  • Phone: 571-278-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberCPED4831
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: