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General NPI Number Information
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NPI Number | 1699410282
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Entity Type | Organization
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Legal Business Name | MONTANO NEUROLOGY CARE GROUP
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 520 SUPERIOR AVE STE 200
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3642
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Country | US
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Telephone | 949-726-9798
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Fax | 949-449-8282
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Provider Business Mailing Address
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Address Line | PO BOX 12588
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City | COSTA MESA
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State | CA
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Zip | 92627-8404
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Country | US
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Telephone | 949-910-0292
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK ANTHONY MONTANO
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Credential | MD
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Telephone | 949-910-0292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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