Healthcare Provider Details

I. General information

NPI: 1831695352
Provider Name (Legal Business Name): MICHAL ALICE MONTANA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MICHAL ALICE HOENECKE

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NW 5TH ST
REDMOND OR
97756-1869
US

IV. Provider business mailing address

14350 MERIDIAN PKWY # 2
RIVERSIDE CA
92518-3035
US

V. Phone/Fax

Practice location:
  • Phone: 541-526-6635
  • Fax: 541-526-6636
Mailing address:
  • Phone: 951-827-7669
  • Fax: 951-827-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: