Healthcare Provider Details

I. General information

NPI: 1962083238
Provider Name (Legal Business Name): NATALIE SOFIA MONTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 S EL MOLINO AVE APT 14
PASADENA CA
91101-2947
US

IV. Provider business mailing address

266 S EL MOLINO AVE APT 14
PASADENA CA
91101-2947
US

V. Phone/Fax

Practice location:
  • Phone: 305-915-5909
  • Fax:
Mailing address:
  • Phone: 305-915-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: