Provider Demographics
NPI:1659357234
Name:MONTEMAYOR, GERTRUDES (MD)
Entity Type:Individual
Prefix:
First Name:GERTRUDES
Middle Name:
Last Name:MONTEMAYOR
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 1:251 TURN PIKE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8098
Mailing Address - Country:US
Mailing Address - Phone:916-985-9300
Mailing Address - Fax:916-355-1217
Practice Address - Street 1:251 TURN PIKE DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8098
Practice Address - Country:US
Practice Address - Phone:916-985-9300
Practice Address - Fax:916-355-1217
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 077539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF96585Medicare UPIN
00G775390Medicare PIN