Healthcare Provider Details

I. General information

NPI: 1528041050
Provider Name (Legal Business Name): ARLENE MAVIS MONTOYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W COAST HWY STE 100
NEWPORT BEACH CA
92663-4087
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 949-645-6272
  • Fax: 949-999-0151
Mailing address:
  • Phone: 800-883-7243
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA42060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: