Healthcare Provider Details

I. General information

NPI: 1427579754
Provider Name (Legal Business Name): ZAYDEE MONTANO RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21772 S ELLSWORTH LOOP RD
QUEEN CREEK AZ
85142-7709
US

IV. Provider business mailing address

1684 CALLE MARQUESA
PONCE PR
00716-0504
US

V. Phone/Fax

Practice location:
  • Phone: 370-048-0512
  • Fax:
Mailing address:
  • Phone: 480-227-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34503
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60556
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: