Provider Demographics
NPI:1265204218
Name:RICHARD, MONTOYIA D
Entity type:Individual
Prefix:
First Name:MONTOYIA
Middle Name:D
Last Name:RICHARD
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 1:5500 HIGHLAND DR APT 1221
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-2066
Mailing Address - Country:US
Mailing Address - Phone:501-944-6576
Mailing Address - Fax:
Practice Address - Street 1:5500 HIGHLAND DR APT 1221
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-2066
Practice Address - Country:US
Practice Address - Phone:501-944-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR931223482347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle