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General NPI Number Information
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NPI Number | 1083338826
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Entity Type | Organization
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Legal Business Name | MONTE VISTA MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 9655 MONTE VISTA AVE STE 405
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City | MONTCLAIR
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State | CA
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Zip | 91763-2238
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Country | US
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Telephone | 909-230-0101
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Fax | 909-445-1122
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Provider Business Mailing Address
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Address Line | 9655 MONTE VISTA AVE STE 405
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City | MONTCLAIR
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State | CA
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Zip | 91763-2238
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Country | US
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Telephone | 909-230-0101
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Fax | 909-445-1122
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Authorized Official
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Title or Position | CFO/SECRETARY
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Name | AMY BAUTISTA
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Credential | NP
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Telephone | 909-230-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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