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General NPI Number Information
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NPI Number | 1720787898
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Entity Type | Individual
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Provider Name | ANDREA MONTENEGRO
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Gender | Female
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 7545 METROPOLITAN DR
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City | SAN DIEGO
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State | CA
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Zip | 92108-4402
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Country | US
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Telephone | 855-232-5796
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Fax |
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Provider Business Mailing Address
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Address Line | 4019 UTAH ST APT 7
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City | SAN DIEGO
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State | CA
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Zip | 92104-2571
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Country | US
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Telephone |
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Fax |
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 696814
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License Number State | CA
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