Provider Demographics
NPI:1639927817
Name:MONTIJO, CARRA (PNP)
Entity type:Individual
Prefix:
First Name:CARRA
Middle Name:
Last Name:MONTIJO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 E RANCH RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8373
Mailing Address - Country:US
Mailing Address - Phone:602-315-2362
Mailing Address - Fax:
Practice Address - Street 1:961 E RANCH RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-8373
Practice Address - Country:US
Practice Address - Phone:602-315-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ282792363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics