Provider Demographics
NPI:1528274867
Name:KAUFELDT MONTANO, DENESE DAWN (PT)
Entity type:Individual
Prefix:DR
First Name:DENESE
Middle Name:DAWN
Last Name:KAUFELDT MONTANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:DENESE
Other - Middle Name:DAWN
Other - Last Name:KAUFELDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11656 BUTTERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3956
Mailing Address - Country:US
Mailing Address - Phone:760-835-8455
Mailing Address - Fax:
Practice Address - Street 1:22995 MILL CREEK DR # A
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1215
Practice Address - Country:US
Practice Address - Phone:949-707-5555
Practice Address - Fax:949-707-5706
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18559174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist