Provider Demographics
NPI:1609918978
Name:MONTEMAYOR, MANUEL (MD)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:MONTEMAYOR
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 1:727 W SAN MARCOS BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1244
Mailing Address - Country:US
Mailing Address - Phone:760-736-8810
Mailing Address - Fax:760-736-3157
Practice Address - Street 1:727 W SAN MARCOS BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1244
Practice Address - Country:US
Practice Address - Phone:760-736-8810
Practice Address - Fax:760-736-3157
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51037208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G13480Medicare UPIN