1235193160 NPI number — JAMES M MONTOYA MD

Table of content: JAMES M MONTOYA MD (NPI 1235193160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235193160 NPI number — JAMES M MONTOYA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTOYA
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235193160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4150 V ST STE 2100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95817-1460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-734-4652
Provider Business Mailing Address Fax Number:
916-734-7950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 POWELL ST
Provider Second Line Business Practice Location Address:
SUITE 920
Provider Business Practice Location Address City Name:
EMERYVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94608-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-350-2673
Provider Business Practice Location Address Fax Number:
510-597-9200
Provider Enumeration Date:
04/17/2006

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: 207P00000X , with the licence number:  27182 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: A94685 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 2004-01100 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 271823 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A946850 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00223202 . This is a "RAILROAD" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: P00455070 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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