Provider Demographics
NPI:1619740289
Name:MONTEMAYOR, JEREMY (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:MONTEMAYOR
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 OCEAN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-1272
Mailing Address - Country:US
Mailing Address - Phone:310-849-3535
Mailing Address - Fax:
Practice Address - Street 1:1012 OCEAN VIEW AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-1272
Practice Address - Country:US
Practice Address - Phone:310-849-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027935363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care