MEDICARE: MRS. EMMA P MONTANEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0079620	MD
2	207R00000X	Internal Medicine Physician	24841	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3741957	OTHER	MD	CIGNA/GREAT WEST/BRAVO/ELDERHEALTH
2	03029353	OTHER	MD	AMERICAID
3	BV89-0001	OTHER	MD	CAREFIRST/BC-BS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	305127	OTHER	MD	JOHNS HOPKINS EHP
6	7449511	OTHER	MD	AETNA/PRUDENTIAL NON-HMO
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1225902	OTHER	MD	USA
9	524002	OTHER	MD	AETNA/PRUDENTIAL HMO
10	24841	OTHER	NV	STATE LICENSE

General Provider Information

NPI Number	:	1164414298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMMA P MONTANEZ MD

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

Provider Business Practice Location Address
First Line	:	4275 BURNHAM AVE STE 340
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5400
Country	:	US
Telephone Number	:	702-734-6363
Fax Number	:	702-734-6374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	03/04/2024

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Directions to “ MRS. EMMA P MONTANEZ MD” Practice Location

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