Provider Demographics
NPI:1881625796
Name:MONTOYA, ALBERT CORTES (PA C)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:CORTES
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
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Mailing Address - Street 1:1763 GROGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6455
Mailing Address - Country:US
Mailing Address - Phone:209-725-7149
Mailing Address - Fax:209-726-0134
Practice Address - Street 1:5300 HIGHWAY 49 NORTH
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-0155
Practice Address - Country:US
Practice Address - Phone:209-966-3672
Practice Address - Fax:209-966-5548
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA13797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS90148Medicare UPIN
CA0PA137971Medicare PIN