1922328251 NPI number — DEBBRA ANN MONTOYA PA-C

Table of content: DEBBRA ANN MONTOYA PA-C (NPI 1922328251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922328251 NPI number — DEBBRA ANN MONTOYA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTOYA
Provider First Name:
DEBBRA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922328251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BLACKFIELD DR
Provider Second Line Business Mailing Address:
SUITE # 314
Provider Business Mailing Address City Name:
TIBURON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94920-2053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-728-3796
Provider Business Mailing Address Fax Number:
415-789-5465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BLACKFIELD DR
Provider Second Line Business Practice Location Address:
SUITE # 314
Provider Business Practice Location Address City Name:
TIBURON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94920-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-728-3796
Provider Business Practice Location Address Fax Number:
415-789-5465
Provider Enumeration Date:
06/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  15475 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA748 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1447316310 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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