Provider Demographics
NPI:1457161820
Name:MONTEMAYOR, STEPHANIA
Entity type:Individual
Prefix:
First Name:STEPHANIA
Middle Name:
Last Name:MONTEMAYOR
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 1:415 COLORADO DR
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-5900
Mailing Address - Country:US
Mailing Address - Phone:956-472-0810
Mailing Address - Fax:
Practice Address - Street 1:1145 E ALTON GLOOR BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-0055
Practice Address - Country:US
Practice Address - Phone:956-544-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1005593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine