Provider Demographics
NPI: | 1134411424 |
---|---|
Name: | GARCIA-MONTOYA, NATALIE (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | NATALIE |
Middle Name: | |
Last Name: | GARCIA-MONTOYA |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | DR |
Other - First Name: | NATALIE |
Other - Middle Name: | |
Other - Last Name: | GARCIA |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 8078 E SANTA ANA CANYON RD |
Mailing Address - Street 2: | |
Mailing Address - City: | ANAHEIM |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92808-1108 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-974-2900 |
Mailing Address - Fax: | 714-279-7501 |
Practice Address - Street 1: | 8078 E SANTA ANA CANYON RD |
Practice Address - Street 2: | |
Practice Address - City: | ANAHEIM |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92808-1108 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-974-2900 |
Practice Address - Fax: | 714-279-7501 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-05-05 |
Last Update Date: | 2021-11-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
390200000X | ||
CA | A130720 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | CB219859 | Medicare PIN |