Provider Demographics
NPI:1316361629
Name:MONTOYA, ADAM MATTHEW
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:MATTHEW
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 1:8913 SUMMERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-4578
Mailing Address - Country:US
Mailing Address - Phone:909-781-0250
Mailing Address - Fax:
Practice Address - Street 1:325 W HOSPITALITY LN
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3243
Practice Address - Country:US
Practice Address - Phone:909-266-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor