Healthcare Provider Details

I. General information

NPI: 1881625796
Provider Name (Legal Business Name): ALBERT CORTES MONTOYA PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 HIGHWAY 49 NORTH
MARIPOSA CA
95338-0155
US

IV. Provider business mailing address

1763 GROGAN AVE
MERCED CA
95341-6455
US

V. Phone/Fax

Practice location:
  • Phone: 209-966-3672
  • Fax: 209-966-5548
Mailing address:
  • Phone: 209-725-7149
  • Fax: 209-726-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: