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General NPI Number Information
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NPI Number | 1952169682
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Entity Type | Organization
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Legal Business Name | PRIBYL MONTAGUE MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 3434 VILLA LN STE 380
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City | NAPA
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State | CA
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Zip | 94558-6416
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Country | US
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Telephone | 707-646-4414
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Fax |
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Provider Business Mailing Address
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Address Line | 1860 PENNSYLVANIA AVE
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City | FAIRFIELD
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State | CA
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Zip | 94533-3590
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Country | US
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Telephone | 707-646-4414
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHEA PRIBYL
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Credential | DO
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Telephone | 707-646-4414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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