Healthcare Provider Details

I. General information

NPI: 1780808030
Provider Name (Legal Business Name): ALEX MONTEZ P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 ROLLING OAKS DR SUITE 100
THOUSAND OAKS CA
91361-1023
US

IV. Provider business mailing address

PO BOX 940838
SIMI VALLEY CA
93094-0838
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-7775
  • Fax: 805-557-1074
Mailing address:
  • Phone: 805-433-7777
  • Fax: 805-433-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: