Provider Demographics
NPI:1649825183
Name:MONTOYA, JACQUELINE (NCMA, NCICS, MA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:NCMA, NCICS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 PENNYFIELD AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-4006
Mailing Address - Country:US
Mailing Address - Phone:546-529-9302
Mailing Address - Fax:
Practice Address - Street 1:3750 HUDSON MANOR TER APT 2CE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1133
Practice Address - Country:US
Practice Address - Phone:646-232-6322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty