Provider Demographics
NPI:1841704236
Name:MONTOYA ROLL, ERICK NOEL (SA-C)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:NOEL
Last Name:MONTOYA ROLL
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 GULFTON ST APT 1549
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2648
Mailing Address - Country:US
Mailing Address - Phone:505-659-1762
Mailing Address - Fax:
Practice Address - Street 1:2502 WESTERLAND DR APT 362
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2217
Practice Address - Country:US
Practice Address - Phone:505-659-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15-400246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant