Provider Demographics
NPI:1609833128
Name:MONTZ, AGNES (MD)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:
Last Name:MONTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DRIVE
Mailing Address - Street 2:PROBST STE 214
Mailing Address - City:RANCHO MIRAGO
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-346-5670
Mailing Address - Fax:760-346-1091
Practice Address - Street 1:39000 BOB HOPE DRIVE
Practice Address - Street 2:PROBST STE 214
Practice Address - City:RANCHO MIRAGO
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-346-5670
Practice Address - Fax:760-346-1091
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG084435207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G844350Medicaid
CA00G884350Medicare ID - Type Unspecified
CA00G844350Medicaid