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General NPI Number Information
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NPI Number | 1619005014
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Entity Type | Individual
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Provider Name | MARIA LYDIA MONTENEGRO MD
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2320 SALNAVE RD LAKELAND VILLAGE
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City | MEDICAL LAKE
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State | WA
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Zip | 99022
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Country | US
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Telephone | 509-299-1836
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Fax | 509-299-1906
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Provider Business Mailing Address
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Address Line | 2320 SALNAVE RD LAKELAND VILLAGE
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City | MEDICAL LAKE
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State | WA
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Zip | 99022
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Country | US
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Telephone | 509-299-1836
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Fax | 509-299-1906
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD00021239
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License Number State | WA
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