Provider Demographics
NPI:1023669199
Name:MONTEGNA, IRMA
Entity type:Individual
Prefix:MS
First Name:IRMA
Middle Name:
Last Name:MONTEGNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 CUYAMACA AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2225
Mailing Address - Country:US
Mailing Address - Phone:858-405-9032
Mailing Address - Fax:
Practice Address - Street 1:8717 FLETCHER PKWY APT 351
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3243
Practice Address - Country:US
Practice Address - Phone:619-251-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN9298078OtherDRIVER LICENSE