MEDICARE: ADOLBEN Y MONTESCLAROS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MD17681	AZ
2	207Q00000X	Family Medicine Physician	17681	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093759615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADOLBEN Y MONTESCLAROS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-0188
Country	:	US
Telephone Number	:	520-682-4111
Fax Number	:	520-818-3630

Provider Business Practice Location Address
First Line	:	5224 W DOVE CENTRE RD
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85658
Country	:	US
Telephone Number	:	520-616-1445
Fax Number	:	520-616-1446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	06/18/2018

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