Individual
ANTHONY MICHAEL MONTEFUSCO IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13855 E 14TH ST, SAN LEANDRO, CA 94578-2611
(209) 342-2300
(209) 524-4240
Mailing address
4301 NORTHSTAR WAY, MODESTO, CA 95356-9262
(209) 342-2300
(209) 524-4240
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A65978
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A659780
BLUE SHIELD
CA
05
—
00A659780
—
CA
Enumeration date
11/02/2005
Last updated
05/28/2008
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