Healthcare Provider Details

I. General information

NPI: 1861785768
Provider Name (Legal Business Name): MARVI MARIE LLENADO MONTANO-IP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 PRAIRIE CITY RD
FOLSOM CA
95630
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-351-4800
  • Fax: 916-351-4899
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA127020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: