MEDICARE: NATALIE MONTOYA

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	1223G0001X	General Practice Dentistry	110535	CA

General Provider Information

NPI Number	:	1528756087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE MONTOYA

Provider Business Mailing Address
First Line	:	5228 CARRYBACK AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-2801
Country	:	US
Telephone Number	:	408-886-4822
Fax Number	:

Provider Business Practice Location Address
First Line	:	5228 CARRYBACK AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-2801
Country	:	US
Telephone Number	:	408-886-4822
Fax Number	:

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

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	08/14/2024

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