=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306680640
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC SEBASTIAN MONTALVO II
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2024
-----------------------------------------------------
Last Update Date | 02/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 GREGORY LN STE 242
-----------------------------------------------------
City | PLEASANT HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94523-2846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-689-1020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2242 POLK ST APT 313
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94109-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-688-5060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 111584
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------