Provider Information for 1215068390
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ANA R MONTENEGRO
Other Names:Former Name:ANA R BETETASex: Female
NPI: 1215068390
Last Updated: 2011-08-31
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1215068390 | ||||||||
| Enumeration Date | 2007-03-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 15339 SATICOY ST. VAN NUYS, CA 91401 United States Phone: 818-876-2072 | Fax: | ||||||||
| Primary Practice Address | 15339 SATICOY ST VAN NUYS, CA 91406-3345 United States Phone: 818-267-2743 | Fax: | ||||||||
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