Provider Demographics
NPI:1639523855
Name:MONTES, ROBERTO CARLOS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:CARLOS
Last Name:MONTES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:C
Other - Last Name:MONTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSY D
Mailing Address - Street 1:129 MEDICINE HORSE DR
Mailing Address - Street 2:
Mailing Address - City:TO'HAJIILEE
Mailing Address - State:NM
Mailing Address - Zip Code:87026
Mailing Address - Country:US
Mailing Address - Phone:505-908-2307
Mailing Address - Fax:505-908-2572
Practice Address - Street 1:80 B VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:ACOMA
Practice Address - State:NM
Practice Address - Zip Code:87034
Practice Address - Country:US
Practice Address - Phone:505-552-5300
Practice Address - Fax:505-552-5490
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34858103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34858OtherLICENSE PSYCHOLOGIST
NMH3451Medicaid