1467781328 NPI number — ROBERTO MONTOYA M.D., P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467781328 NPI number — ROBERTO MONTOYA M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERTO MONTOYA M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1467781328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLAIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77402-0128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-907-4456
Provider Business Mailing Address Fax Number:
281-833-3323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1810 NANTUCKET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77057-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-907-4456
Provider Business Practice Location Address Fax Number:
281-833-3323
Provider Enumeration Date:
12/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MONTOYA
Authorized Official First Name:
ROBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
713-907-4456

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  E4905 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00AB79 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10043543 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 401073 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 031816401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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