Provider Demographics
NPI:1982395950
Name:MONTENEGRO-BALOT, STARLET (MA)
Entity Type:Individual
Prefix:
First Name:STARLET
Middle Name:
Last Name:MONTENEGRO-BALOT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:STARLET
Other - Middle Name:
Other - Last Name:BALOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6103 BAVA CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-5009
Mailing Address - Country:US
Mailing Address - Phone:408-712-0941
Mailing Address - Fax:
Practice Address - Street 1:2625 ZANKER RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-2130
Practice Address - Country:US
Practice Address - Phone:408-468-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator