Provider Demographics
NPI:1073108676
Name:MONTOYA, LAURA A (HIS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 VILLA VERDE DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1395
Mailing Address - Country:US
Mailing Address - Phone:505-730-2504
Mailing Address - Fax:
Practice Address - Street 1:1651 GALISTEO ST STE 1A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4752
Practice Address - Country:US
Practice Address - Phone:505-988-4327
Practice Address - Fax:505-988-4327
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMHAD0946237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist