Montlake Diagnostics, PLLC

Primary specialty

Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X

Legal business name

MONTLAKE DIAGNOSTICS, PLLC

Practice address

1819 N Main Ave # 218
San Antonio, TX 78212-3941

Phone

(210) 714-5532

NPI assigned

Feb 12, 2016

Last updated

Nov 16, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. William Alec Tisdall, M.D.

Title

Owner

Phone

(210) 714-5532

Specialties & licenses 4

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1760841258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1819 N MAIN AVE # 218",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782123941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1819 N MAIN AVE # 218",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782123941",
            "telephone_number": "210-714-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTLAKE DIAGNOSTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-12",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "TISDALL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "ALEC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-714-5532",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "246ZE0600X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204R00000X",
            "taxonomy_group": "",
            "desc": "Electrodiagnostic Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shyra Donee Montgomery, BSN, RN
• Janie Alejandra Montiel, MS, LMFT
• Katheryn Faye Montiel
• Rebeca Montiel
• Romulo Esteban Montilla, PH. D.
• Jessica Montney, LVN
• Mariangela Montoya Fierro
• Amanda Dee Montoya-Cuellar, LPC
• Ramona A Montoya-Cuellar, LPC
• Blanca Leticia Montoya

• Clinical Neurophysiology Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Clinical Neurophysiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.