Basic Information
| Provider Information | |||||||||
| NPI: | 1073893186 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTEZ | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | GAYLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 344 | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271020344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 151 EVERETT AVE | ||||||||
| Address2: | |||||||||
| City: | CHELSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178848300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2011 | ||||||||
| LastUpdateDate: | 07/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A117830 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 254706 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 2018-01904 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.