1396028767 NPI number — DR. GUILLERMO VALDES MONTEMAYOR M.D., M.B.A

Table of content: DR. GUILLERMO VALDES MONTEMAYOR M.D., M.B.A (NPI 1396028767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396028767 NPI number — DR. GUILLERMO VALDES MONTEMAYOR M.D., M.B.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALDES MONTEMAYOR
Provider First Name:
GUILLERMO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.B.A
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VALDES
Provider Other First Name:
GUILLERMO
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., M.B.A.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1396028767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 WEST END AVENUE
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-789-1422
Provider Business Mailing Address Fax Number:
917-464-9897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 WEST END AVENUE
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-789-1422
Provider Business Practice Location Address Fax Number:
917-464-9897
Provider Enumeration Date:
09/22/2011

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: 2084P0804X , with the licence number:  280656 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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