Provider Demographics
NPI:1609692177
Name:PEARCE, MONTANA MICHAEL (RN)
Entity type:Individual
Prefix:
First Name:MONTANA
Middle Name:MICHAEL
Last Name:PEARCE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 DRURY CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-2935
Mailing Address - Country:US
Mailing Address - Phone:951-497-9383
Mailing Address - Fax:
Practice Address - Street 1:4361 DRURY CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-2935
Practice Address - Country:US
Practice Address - Phone:951-497-9383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95198917163W00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered Nurse