Provider Demographics
NPI:1508816414
Name:MONTOY, JORGE FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:FRANCISCO
Last Name:MONTOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 JENSEN AVE
Mailing Address - Street 2:#102
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2250
Mailing Address - Country:US
Mailing Address - Phone:559-875-6970
Mailing Address - Fax:559-875-1469
Practice Address - Street 1:2514 JENSEN AVE
Practice Address - Street 2:#102
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2250
Practice Address - Country:US
Practice Address - Phone:559-875-6970
Practice Address - Fax:559-875-1469
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G464270Medicaid
CAA50385Medicare UPIN
CA00G464270Medicaid