Provider Demographics
NPI:1336585256
Name:MONTOYA, TALA A (NP)
Entity Type:Individual
Prefix:MISS
First Name:TALA
Middle Name:A
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 HAMILTON ST
Mailing Address - Street 2:#3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-1472
Mailing Address - Country:US
Mailing Address - Phone:415-306-4334
Mailing Address - Fax:
Practice Address - Street 1:360 HAMILTON ST
Practice Address - Street 2:#3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-1472
Practice Address - Country:US
Practice Address - Phone:415-306-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-18
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21212363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care