Provider Demographics
NPI:1235639618
Name:MONTOYA, MITCHELL T
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:T
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 PASEO DEL PUEBLO SUR STE 3
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5978
Mailing Address - Country:US
Mailing Address - Phone:575-751-9327
Mailing Address - Fax:
Practice Address - Street 1:1350 PASEO DEL PUEBLO SUR STE 3
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5978
Practice Address - Country:US
Practice Address - Phone:575-751-9327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0906237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist