Provider Demographics
NPI:1710224993
Name:MONTEMAYOR, EDUARDO DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:DANIEL
Last Name:MONTEMAYOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 ENNIS JOSLIN RD APT 510
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4376
Mailing Address - Country:US
Mailing Address - Phone:956-642-6266
Mailing Address - Fax:
Practice Address - Street 1:5540 SARATOGA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2953
Practice Address - Country:US
Practice Address - Phone:361-993-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08135363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant