Provider Demographics
NPI:1922328251
Name:MONTOYA, DEBBRA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBBRA
Middle Name:ANN
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BLACKFIELD DR
Mailing Address - Street 2:SUITE # 314
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2053
Mailing Address - Country:US
Mailing Address - Phone:415-728-3796
Mailing Address - Fax:415-789-5465
Practice Address - Street 1:1 BLACKFIELD DR
Practice Address - Street 2:SUITE # 314
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-2053
Practice Address - Country:US
Practice Address - Phone:415-728-3796
Practice Address - Fax:415-789-5465
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15475363AM0700X
NVPA748363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1447316310Medicaid