Healthcare Provider Details

I. General information

NPI: 1912583642
Provider Name (Legal Business Name): ROSE MONTPLAISIR SANDOVAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N ORANGE ST STE 202
MISSOULA MT
59802-2951
US

IV. Provider business mailing address

PO BOX 31001 4114
PASADENA CA
91110-4114
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-3362
  • Fax:
Mailing address:
  • Phone: 406-327-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMED-PHYS-LIC-175671
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMED-PHYS-LIC-175671
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: