Healthcare Provider Details

I. General information

NPI: 1609692177
Provider Name (Legal Business Name): MONTANA MICHAEL PEARCE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4361 DRURY CT
RIVERSIDE CA
92505-2935
US

IV. Provider business mailing address

4361 DRURY CT
RIVERSIDE CA
92505-2935
US

V. Phone/Fax

Practice location:
  • Phone: 951-497-9383
  • Fax:
Mailing address:
  • Phone: 951-497-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95198917
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: