Provider Demographics
NPI:1003471772
Name:MONTOYA, ELYSSA MONET
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:MONET
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 ANTRIM DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-2930
Mailing Address - Country:US
Mailing Address - Phone:757-585-3948
Mailing Address - Fax:
Practice Address - Street 1:731 ANTRIM DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2930
Practice Address - Country:US
Practice Address - Phone:757-585-3948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver