Provider Demographics
NPI:1659389807
Name:MONTES, ROSA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:MONTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:GUEVARA
Other - Last Name:MONTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2829 BABCOCK RD STE 636
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6014
Mailing Address - Country:US
Mailing Address - Phone:210-615-8460
Mailing Address - Fax:210-615-0406
Practice Address - Street 1:2829 BABCOCK RD STE 636
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6014
Practice Address - Country:US
Practice Address - Phone:210-615-8460
Practice Address - Fax:210-615-0406
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX275944ZN97OtherPTAN#
TX173951805Medicaid
TXH83535Medicare UPIN