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General NPI Number Information
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NPI Number | 1962697649
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Entity Type | Organization
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Legal Business Name | M M ONTIVEROS MD PA
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 311 CAMDEN ST SUITE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78215-2012
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Country | US
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Telephone | 210-281-9800
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Fax | 210-281-1001
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Provider Business Mailing Address
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Address Line | 311 CAMDEN ST SUITE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78215-2012
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Country | US
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Telephone | 210-281-9800
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Fax | 210-281-1001
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRIS MATHIS
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Credential |
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Telephone | 210-525-1668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | H5196
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License Number State | TX
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