Provider Demographics
NPI:1629297163
Name:MONTENEGRO, ROMEO UY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:UY
Last Name:MONTENEGRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14427 CHASE ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3020
Mailing Address - Country:US
Mailing Address - Phone:818-830-7751
Mailing Address - Fax:818-891-7892
Practice Address - Street 1:14427 CHASE ST
Practice Address - Street 2:STE. 100
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3020
Practice Address - Country:US
Practice Address - Phone:818-830-7751
Practice Address - Fax:818-891-7892
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 80659208D00000X
CAG80659208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG080659Medicaid