Basic Information
Provider Information
NPI: 1790268001
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONTERROSAS
FirstName: SARA
MiddleName: G
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 215 SHUMAN BLVD STE 401
Address2:  
City: NAPERVILLE
State: IL
PostalCode: 605638123
CountryCode: US
TelephoneNumber: 6303035380
FaxNumber: 6303035385
Practice Location
Address1: 1940 W ORANGEWOOD AVE STE 110
Address2:  
City: ORANGE
State: CA
PostalCode: 928685042
CountryCode: US
TelephoneNumber: 7149782996
FaxNumber: 7149782824
Other Information
ProviderEnumerationDate: 09/12/2018
LastUpdateDate: 06/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
237700000X8408CAY Speech, Language and Hearing Service ProvidersHearing Instrument Specialist 

No ID Information.


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