Healthcare Provider Details

I. General information

NPI: 1689618746
Provider Name (Legal Business Name): DIANA MONTGOMERY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA MONTGOMERY M.D.

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 SACRAMENTO ST SUITE 301
SAN FRANCISCO CA
94118-1636
US

IV. Provider business mailing address

3905 SACRAMENTO ST SUITE 301
SAN FRANCISCO CA
94118-1636
US

V. Phone/Fax

Practice location:
  • Phone: 415-752-8038
  • Fax:
Mailing address:
  • Phone: 415-752-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA88405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: