Provider Demographics
NPI:1558931667
Name:MONTOYA, DEBRA ALICE
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ALICE
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 DEER HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4853
Mailing Address - Country:US
Mailing Address - Phone:951-285-2865
Mailing Address - Fax:
Practice Address - Street 1:2160 DEER HAVEN DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-4853
Practice Address - Country:US
Practice Address - Phone:951-285-2865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP6421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist