Provider Demographics
NPI:1225271638
Name:MONTOYA, JOSE A (LAC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 E BASELINE RD
Mailing Address - Street 2:STE A-1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1527
Mailing Address - Country:US
Mailing Address - Phone:480-777-5522
Mailing Address - Fax:
Practice Address - Street 1:1840 E BASELINE RD
Practice Address - Street 2:STE A-1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1527
Practice Address - Country:US
Practice Address - Phone:480-777-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0630171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist