Provider Demographics
NPI:1396495867
Name:MONTANO, MARIO (RN)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:MONTANO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DIAMANTE PL
Mailing Address - Street 2:
Mailing Address - City:RIO COMMUNITIES
Mailing Address - State:NM
Mailing Address - Zip Code:87002-6162
Mailing Address - Country:US
Mailing Address - Phone:505-720-7571
Mailing Address - Fax:
Practice Address - Street 1:125 DIAMANTE PL
Practice Address - Street 2:
Practice Address - City:RIO COMMUNITIES
Practice Address - State:NM
Practice Address - Zip Code:87002-6162
Practice Address - Country:US
Practice Address - Phone:505-720-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-80443163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care