Healthcare Provider Details

I. General information

NPI: 1992719199
Provider Name (Legal Business Name): MARIA MONTENEGRO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TRANCAS ST STE 256
NAPA CA
94558-2921
US

IV. Provider business mailing address

7330 SAN PEDRO STE 405
SAN ANTONIO TX
78216-6234
US

V. Phone/Fax

Practice location:
  • Phone: 707-703-4863
  • Fax:
Mailing address:
  • Phone: 210-344-2673
  • Fax: 210-344-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP30020425
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC136695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: