Provider Demographics
NPI:1609378934
Name:MONTERROSA, ANA MARIA (RDA 37451)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:MONTERROSA
Suffix:
Gender:F
Credentials:RDA 37451
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43020 BALE CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-6269
Mailing Address - Country:US
Mailing Address - Phone:661-210-5554
Mailing Address - Fax:
Practice Address - Street 1:43020 BALE CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-6269
Practice Address - Country:US
Practice Address - Phone:661-210-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA37451126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37451Medicaid