Healthcare Provider Details

I. General information

NPI: 1669544631
Provider Name (Legal Business Name): MICHAEL RICHARD MONTEIRO SR. CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 DABNEY RD SUITE C
RICHMOND VA
23230-3361
US

IV. Provider business mailing address

6001 RED SETTER LN
MOSELEY VA
23120-2233
US

V. Phone/Fax

Practice location:
  • Phone: 804-649-9043
  • Fax:
Mailing address:
  • Phone: 804-370-6296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: