Provider Demographics
NPI:1780727735
Name:MONTOYA, MARIETTA (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIETTA
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 VIVIAN DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4047
Mailing Address - Country:US
Mailing Address - Phone:505-858-3011
Mailing Address - Fax:
Practice Address - Street 1:129 CANAL STREET
Practice Address - Street 2:
Practice Address - City:JEMEZ PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87024
Practice Address - Country:US
Practice Address - Phone:505-834-3175
Practice Address - Fax:505-834-0238
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor