Provider Demographics
NPI:1902172281
Name:SANDRA L. MONTOYA, PH.D., PC
Entity Type:Organization
Organization Name:SANDRA L. MONTOYA, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-275-6457
Mailing Address - Street 1:3900 JUAN TABO BLVD NE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3984
Mailing Address - Country:US
Mailing Address - Phone:505-275-6457
Mailing Address - Fax:505-298-3939
Practice Address - Street 1:3900 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE 11
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3984
Practice Address - Country:US
Practice Address - Phone:505-275-6457
Practice Address - Fax:505-298-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM640103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1447314091OtherTYPE 1 NPI