1164414298 NPI number — MRS. EMMA P MONTANEZ MD

Table of content: MRS. EMMA P MONTANEZ MD (NPI 1164414298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164414298 NPI number — MRS. EMMA P MONTANEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTANEZ
Provider First Name:
EMMA
Provider Middle Name:
P
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTANEZ-LEWIS
Provider Other First Name:
EMMA
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164414298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6355 S BUFFALO DR FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89113-2133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-216-3346
Provider Business Mailing Address Fax Number:
702-671-6883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4275 BURNHAM AVE STE 340
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89119-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-734-6363
Provider Business Practice Location Address Fax Number:
702-734-6374
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D0079620 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 24841 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3741957 . This is a "CIGNA/GREAT WEST/BRAVO/ELDERHEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 03029353 . This is a "AMERICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: BV89-0001 . This is a "CAREFIRST/BC-BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1164414298 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 305127 . This is a "JOHNS HOPKINS EHP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7449511 . This is a "AETNA/PRUDENTIAL NON-HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 854003800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225902 . This is a "USA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 524002 . This is a "AETNA/PRUDENTIAL HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 24841 . This is a "STATE LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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