Provider Demographics
NPI:1376210336
Name:MONTOYA, RONALD LEO VAZQUEZ (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:RONALD LEO
Middle Name:VAZQUEZ
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:MR
Other - First Name:RONALD
Other - Middle Name:VAZQUEZ
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1800 W. CHARLESTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:818-983-5393
Mailing Address - Fax:
Practice Address - Street 1:1800 W. CHARLESTON BLVD.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:818-983-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV844873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily