Provider Demographics
NPI:1699410282
Name:MONTANO NEUROLOGY CARE GROUP
Entity Type:Organization
Organization Name:MONTANO NEUROLOGY CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-910-0292
Mailing Address - Street 1:PO BOX 12588
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-8404
Mailing Address - Country:US
Mailing Address - Phone:949-910-0292
Mailing Address - Fax:
Practice Address - Street 1:520 SUPERIOR AVE STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3642
Practice Address - Country:US
Practice Address - Phone:949-726-9798
Practice Address - Fax:949-449-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty