Healthcare Provider Details

I. General information

NPI: 1255369229
Provider Name (Legal Business Name): PETER HOWLAND MONFORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 BARRANCA PKWY 104
IRVINE CA
92604-4709
US

IV. Provider business mailing address

PO BOX 3699
NEWPORT BEACH CA
92659-8699
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-1248
  • Fax: 949-559-1165
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG45067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: