Provider Demographics
NPI:1619341708
Name:MONTANARO, ZACHARY (NAVY IDC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:MONTANARO
Suffix:
Gender:M
Credentials:NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 BANCROFT DR # 1
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-2669
Mailing Address - Country:US
Mailing Address - Phone:518-369-3511
Mailing Address - Fax:
Practice Address - Street 1:3150 BANCROFT DR # 1
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-2669
Practice Address - Country:US
Practice Address - Phone:518-369-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Multi-Specialty