Provider Demographics
NPI:1538726534
Name:MONTOYA, AIMEE MARGARET (DPM)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:MARGARET
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:MARGARET
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:1021 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2622
Mailing Address - Country:US
Mailing Address - Phone:310-903-9115
Mailing Address - Fax:
Practice Address - Street 1:16 E FERN AVE STE A
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4000
Practice Address - Country:US
Practice Address - Phone:909-792-6066
Practice Address - Fax:909-792-4424
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL6896213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery