Provider Demographics
NPI:1588226799
Name:CHRISTIAN, MONTOYA M
Entity Type:Individual
Prefix:
First Name:MONTOYA
Middle Name:M
Last Name:CHRISTIAN
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 1:10926 DAVID TAYLOR DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1042
Mailing Address - Country:US
Mailing Address - Phone:980-322-7279
Mailing Address - Fax:866-908-6945
Practice Address - Street 1:10926 DAVID TAYLOR DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1042
Practice Address - Country:US
Practice Address - Phone:980-322-7279
Practice Address - Fax:866-908-6945
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2279G0305X, 1041C0700X, 376K00000X
NC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No2279G0305XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeriatric Care
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No376K00000XNursing Service Related ProvidersNurse's Aide