Provider Demographics
NPI:1457162109
Name:MONTIEL, FEDORA
Entity type:Individual
Prefix:
First Name:FEDORA
Middle Name:
Last Name:MONTIEL
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 1:11403 LOKI ST
Mailing Address - Street 2:
Mailing Address - City:WHITE SANDS
Mailing Address - State:NM
Mailing Address - Zip Code:88002-1125
Mailing Address - Country:US
Mailing Address - Phone:254-392-0495
Mailing Address - Fax:
Practice Address - Street 1:11403 LOKI ST
Practice Address - Street 2:
Practice Address - City:WHITE SANDS
Practice Address - State:NM
Practice Address - Zip Code:88002-1125
Practice Address - Country:US
Practice Address - Phone:254-392-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker