Provider Demographics
NPI:1124455449
Name:MONTENEGRO OREAMUNO, MARIA JOSE
Entity type:Individual
Prefix:
First Name:MARIA JOSE
Middle Name:
Last Name:MONTENEGRO OREAMUNO
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 1:19655 HARVARD PL
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1023
Mailing Address - Country:US
Mailing Address - Phone:970-964-8638
Mailing Address - Fax:
Practice Address - Street 1:19655 HARVARD PL
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3368
Practice Address - Country:US
Practice Address - Phone:970-964-8638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-001383183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist