Individual
BRIAN MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5976 OMEGA ST, RIVERSIDE, CA 92506-4744
(951) 315-7630
Mailing address
5976 OMEGA ST, RIVERSIDE, CA 92506-4744
(951) 315-7630
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA52698
CA
Other
Enumeration date
08/06/2015
Last updated
08/06/2015
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