Basic Information
| Provider Information | |||||||||
| NPI: | 1528196797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTANEZ | ||||||||
| FirstName: | DURANDA | ||||||||
| MiddleName: | COSETTE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PH.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ORELLANA | ||||||||
| OtherFirstName: | DURANDA | ||||||||
| OtherMiddleName: | COSETTE | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 505 S MAIN ST | ||||||||
| Address2: | SUITE 249 | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880011206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055275823 | ||||||||
| FaxNumber: | 5055275886 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 S MAIN ST | ||||||||
| Address2: | SUITE 249 | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880011206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055275823 | ||||||||
| FaxNumber: | 5055275886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 06/07/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 103TC0700X | 0944 | NM | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.