Provider Demographics
NPI:1164805420
Name:MONTANEZ, MARTHA Y (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:Y
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N ZARAGOZA RD STE A-107
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7905
Mailing Address - Country:US
Mailing Address - Phone:915-500-1100
Mailing Address - Fax:833-913-2385
Practice Address - Street 1:1550 N ZARAGOZA RD STE A-107
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7905
Practice Address - Country:US
Practice Address - Phone:915-500-1100
Practice Address - Fax:833-913-2385
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9111207Q00000X
NMMD2017-0911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty