Healthcare Provider Details

I. General information

NPI: 1710505656
Provider Name (Legal Business Name): ROCIO MONTES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ADELINE ST
OAKLAND CA
94607-2608
US

IV. Provider business mailing address

2444 89TH AVE
OAKLAND CA
94605-3930
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-9610
  • Fax:
Mailing address:
  • Phone: 510-910-5269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86156080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: