Provider Demographics
NPI:1780021816
Name:SMITH, MONTIQUE LECHA
Entity Type:Individual
Prefix:
First Name:MONTIQUE
Middle Name:LECHA
Last Name:SMITH
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 1:1050 E FLAMINGO ROAD STE S-107
Mailing Address - Street 2:MAPLE STAR NEVADA
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119
Mailing Address - Country:US
Mailing Address - Phone:702-733-8098
Mailing Address - Fax:702-395-6457
Practice Address - Street 1:1050 E FLAMINGO ROAD STE S-107
Practice Address - Street 2:MAPLE STAR NEVADA
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-733-8098
Practice Address - Fax:702-395-6457
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker