Provider Demographics
NPI:1164414298
Name:MONTANEZ, EMMA P (MD)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:P
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:EMMA
Other - Middle Name:P
Other - Last Name:MONTANEZ-LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:4275 BURNHAM AVE STE 340
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5400
Practice Address - Country:US
Practice Address - Phone:702-734-6363
Practice Address - Fax:702-734-6374
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0079620207R00000X
NV24841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3741957OtherCIGNA/GREAT WEST/BRAVO/ELDERHEALTH
MD03029353OtherAMERICAID
MDBV89-0001OtherCAREFIRST/BC-BS
NV1164414298Medicaid
MD305127OtherJOHNS HOPKINS EHP
MD7449511OtherAETNA/PRUDENTIAL NON-HMO
MD854003800Medicaid
MD1225902OtherUSA
MD524002OtherAETNA/PRUDENTIAL HMO
NV24841OtherSTATE LICENSE
OH2449201Medicaid
OH2355062OtherRHC MEDICAID NUMBER
OH408735OtherUNITED HEALTH CARE