Basic Information
| Provider Information | |||||||||
| NPI: | 1265986707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTOYA | ||||||||
| FirstName: | GABRIELLE | ||||||||
| MiddleName: | ARIANE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2302 ANNA JEAN CT | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875055201 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7011 CAMPUS DR STE 205 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809203104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194664809 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2016 | ||||||||
| LastUpdateDate: | 07/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 106E00000X | 11896 | CO | Y |
No ID Information.