MEDICARE: MIA RAQUEL MONTOYA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1912534413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA RAQUEL MONTOYA MD

Provider Business Mailing Address
First Line	:	650 JEREMY CT
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 E DATE PL
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-6720
Country	:	US
Telephone Number	:	833-574-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	06/26/2023

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