Healthcare Provider Details

I. General information

NPI: 1801900832
Provider Name (Legal Business Name): LAURA STEPHANIE MONTEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA STEPHANIE BELLOVIN PA-C

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 NE 6TH AVE
ESTACADA OR
97023-9312
US

IV. Provider business mailing address

PO BOX 546
GRESHAM OR
97030-0132
US

V. Phone/Fax

Practice location:
  • Phone: 503-630-8550
  • Fax:
Mailing address:
  • Phone: 541-782-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA00928
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00928
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: