Healthcare Provider Details

I. General information

NPI: 1194871376
Provider Name (Legal Business Name): BRIAN LEONARDO MONTENEGRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHBAY MEDICAL CENTER 1200 B GALE WILSON BLVD
FAIRFIELD CA
94533-3552
US

IV. Provider business mailing address

NORTHBAY NEONATOLOGY ASSOCIATES, INC 1860 PENNSYLVANIA AVE, STE 145
FAIRFIELD CA
94533-3547
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-5000
  • Fax:
Mailing address:
  • Phone: 707-646-4052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA113592
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA113592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: