Provider Demographics
NPI:1982712535
Name:MONTELEONE, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MONTELEONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7565 N CEDAR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2687
Mailing Address - Country:US
Mailing Address - Phone:559-446-1000
Mailing Address - Fax:559-438-8887
Practice Address - Street 1:7565 N CEDAR AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2687
Practice Address - Country:US
Practice Address - Phone:559-446-1000
Practice Address - Fax:559-438-8887
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G481010Medicaid
CA0234144OtherSTATE OF WASHINGTON DEPARTMENT OF LABOR
CAA50932Medicare UPIN
CA00G481012Medicare PIN