Provider Demographics
NPI:1205499837
Name:MONTEMAYOR, PETRA JESUS
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:JESUS
Last Name:MONTEMAYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N R ST # 103
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4465
Mailing Address - Country:US
Mailing Address - Phone:559-664-9021
Mailing Address - Fax:
Practice Address - Street 1:117 N R ST # 103
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4465
Practice Address - Country:US
Practice Address - Phone:559-664-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator