Provider Demographics
NPI:1558392449
Name:DE MONTEIRO, CHINNAVUTH PITOU (MD)
Entity Type:Individual
Prefix:DR
First Name:CHINNAVUTH
Middle Name:PITOU
Last Name:DE MONTEIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2415 HIGH SCHOOL AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1800
Mailing Address - Country:US
Mailing Address - Phone:925-687-5210
Mailing Address - Fax:925-687-5091
Practice Address - Street 1:2415 HIGH SCHOOL AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1800
Practice Address - Country:US
Practice Address - Phone:925-687-5210
Practice Address - Fax:925-687-5091
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG73896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73896OtherCA STATE LICENSE
CAG73896OtherCA STATE LICENSE
CABD3163475OtherDEA NUMBER
CA00G738960Medicare PIN
CAG73896OtherCA STATE LICENSE