MEDICARE: DR. ROBERTO EMILIO MONTENEGRO 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	2084P0800X	Psychiatry Physician	A173032	CA
2	2084P0800X	Psychiatry Physician	MD60632843	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164765970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO EMILIO MONTENEGRO MD

Provider Business Mailing Address
First Line	:	4730 UNIVERSITY WAY NE STE 104
Second Line	:	#2245
City	:	SEATTLE
State	:	WA
Zip	:	98105-4424
Country	:	US
Telephone Number	:	425-954-3127
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 UNIVERSITY WAY NE STE 104
Second Line	:	#2245
City	:	SEATTLE
State	:	WA
Zip	:	98105-4424
Country	:	US
Telephone Number	:	425-954-3127
Fax Number	:

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

Provider Enumeration Date	:	03/29/2013
Last Update Date	:	05/07/2025

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