Provider Demographics
NPI:1548617343
Name:LANDEROS MONTOYA, JUAN JOSE
Entity Type:Individual
Prefix:
First Name:JUAN JOSE
Middle Name:
Last Name:LANDEROS 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 1:9761 SW HILLSBORO HWY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-9264
Mailing Address - Country:US
Mailing Address - Phone:503-577-6862
Mailing Address - Fax:
Practice Address - Street 1:9761 SW HILLSBORO HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-9264
Practice Address - Country:US
Practice Address - Phone:503-577-6862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-21
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21535225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist