Provider Demographics
NPI:1639982150
Name:MONTOYA, SANDRA (CPO)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WINSTON SALEM AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4784
Mailing Address - Country:US
Mailing Address - Phone:571-278-0380
Mailing Address - Fax:
Practice Address - Street 1:509 VIKING DR STE E
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7323
Practice Address - Country:US
Practice Address - Phone:757-275-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACPED4831224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist