Healthcare Provider Details

I. General information

NPI: 1215499769
Provider Name (Legal Business Name): CAROLYN A MONTES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5090 SHOREHAM PL STE 210
SAN DIEGO CA
92122-5935
US

IV. Provider business mailing address

5090 SHOREHAM PL STE 210
SAN DIEGO CA
92122-5935
US

V. Phone/Fax

Practice location:
  • Phone: 858-926-7010
  • Fax: 858-926-7011
Mailing address:
  • Phone: 858-926-7010
  • Fax: 858-926-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA201919
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA201919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: