Provider Demographics
NPI:1538115258
Name:MONTAZERI, MICHAEL ESPOSITO (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ESPOSITO
Last Name:MONTAZERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:BEHROOZ
Other - Last Name:MONTAZERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:MC#8485
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9001
Mailing Address - Country:US
Mailing Address - Phone:619-471-9199
Mailing Address - Fax:619-543-8255
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MC 8485
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-471-9199
Practice Address - Fax:619-543-8255
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine