Provider Demographics
NPI:1447739685
Name:MONTEMAYOR, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:MONTEMAYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 RANCHO LN STE 40
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3806
Mailing Address - Country:US
Mailing Address - Phone:702-366-0875
Mailing Address - Fax:
Practice Address - Street 1:820 RANCHO LN STE 40
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3806
Practice Address - Country:US
Practice Address - Phone:702-366-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2102646286OtherDRIVER LICENSE