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General NPI Number Information
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NPI Number | 1396119640
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Entity Type | Individual
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Provider Name | MR. DIEGO MONTOYA
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Gender | Male
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Dates
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Enumeration Date | 11/24/2015
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 12002 SAINT HELENA DR
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City | OAKTON
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State | VA
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Zip | 22124-2328
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Country | US
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Telephone | 703-577-3597
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Fax |
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Provider Business Mailing Address
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Address Line | 2118 S LOWELL ST
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City | ARLINGTON
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State | VA
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Zip | 22204-5343
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Country | US
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Telephone | 703-577-8256
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | VA
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