Provider Demographics
NPI:1073563318
Name:MONTOYA, DAVID G (CASE MANAGER)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 EAST JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082
Mailing Address - Country:US
Mailing Address - Phone:719-846-4762
Mailing Address - Fax:
Practice Address - Street 1:220 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740
Practice Address - Country:US
Practice Address - Phone:505-445-2754
Practice Address - Fax:505-445-2225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist