MEDICARE: CAROLINA MONTOYA PA-C

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	363A00000X	Physician Assistant	PA64504	CA

General Provider Information

NPI Number	:	1104671965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA MONTOYA PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1730
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-1058
Country	:	US
Telephone Number	:	760-568-2684
Fax Number	:	760-341-5832

Provider Business Practice Location Address
First Line	:	36101 BOB HOPE DR STE A1
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-2002
Country	:	US
Telephone Number	:	760-321-1315
Fax Number	:	760-321-1094

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

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	01/29/2026

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