Healthcare Provider Details

I. General information

NPI: 1851167308
Provider Name (Legal Business Name): JUAN FERNANDO MANUEL MONTANO CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 FENTON PKWY APT 310
SAN DIEGO CA
92108-4797
US

IV. Provider business mailing address

2420 FENTON PKWY APT 310
SAN DIEGO CA
92108-4797
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-5927
  • Fax:
Mailing address:
  • Phone: 505-803-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number5092
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number5092
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number5092
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number80614
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: