Basic Information
| Provider Information | |||||||||
| NPI: | 1235193160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTOYA | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4150 V ST STE 2100 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167344652 | ||||||||
| FaxNumber: | 9167347950 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 POWELL ST | ||||||||
| Address2: | SUITE 920 | ||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946081826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103502673 | ||||||||
| FaxNumber: | 5105979200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 12/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 27182 | SC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | A94685 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2004-01100 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 271823 | 05 | SC | MEDICAID | 00A946850 | 05 | CA | MEDICAID | P00223202 | 01 | SC | RAILROAD | OTHER | P00455070 | 01 | CA | RAILROAD MEDICARE | OTHER |