Provider Demographics
NPI:1194395137
Name:MONTERO MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MONTERO MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-946-1634
Mailing Address - Street 1:2362 N OXNARD BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2053
Mailing Address - Country:US
Mailing Address - Phone:805-946-1634
Mailing Address - Fax:
Practice Address - Street 1:2362 N OXNARD BLVD STE 102
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2053
Practice Address - Country:US
Practice Address - Phone:409-877-3191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty