Individual
FREDDY L MONTENEGRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
616 E SOUTHERN AVE STE 103, MESA, AZ 85204
(602) 569-3999
(602) 569-3887
Mailing address
1533 E WILLETTA ST, PHOENIX, AZ 85006-2935
(602) 569-3999
(602) 569-3887
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
19900
CA
363LF0000X
Family Nurse Practitioner
19900
CA
363LF0000X
Family Nurse Practitioner
Primary
AP5467
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890635
—
AZ
Enumeration date
01/24/2011
Last updated
10/15/2019
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