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General NPI Number Information
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NPI Number | 1114713724
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Entity Type | Organization
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Legal Business Name | MONTAGE PHYSICIAN ASSOCIATES
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 12 UPPER RAGSDALE DR
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City | MONTEREY
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State | CA
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Zip | 93940-5730
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Country | US
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Telephone | 831-242-3080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX HH
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City | MONTEREY
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State | CA
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Zip | 93942-6032
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Country | US
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Telephone | 831-242-3070
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MARK CARVALHO
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Credential | MD
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Telephone | 831-242-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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