Provider Demographics
NPI:1285307058
Name:MONTERROZA, DOREEN RUTH
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:RUTH
Last Name:MONTERROZA
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 1:2946 CLEARLAND CIR
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-3243
Mailing Address - Country:US
Mailing Address - Phone:650-866-9057
Mailing Address - Fax:
Practice Address - Street 1:2946 CLEARLAND CIR
Practice Address - Street 2:
Practice Address - City:BAY POINT
Practice Address - State:CA
Practice Address - Zip Code:94565-3243
Practice Address - Country:US
Practice Address - Phone:650-866-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66627225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty