Provider Demographics
NPI:1548277403
Name:MONTOYA, SYLVIA M (MD)
Entity type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:M
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:223 S REYMOND ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2622
Mailing Address - Country:US
Mailing Address - Phone:505-647-1376
Mailing Address - Fax:
Practice Address - Street 1:74 JAMES CANYON HIGHWAY
Practice Address - Street 2:
Practice Address - City:CLOUDCROFT
Practice Address - State:NM
Practice Address - Zip Code:88317
Practice Address - Country:US
Practice Address - Phone:505-682-2542
Practice Address - Fax:505-682-3075
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM 90-255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58366Medicaid
NM58366Medicaid