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Individual

MR. KEITH ALLEN MONTGOMERY JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
N.P.

Contact information

Practice address
11965 CACTUS RD, ADELANTO, CA 92301-4906
(760) 561-6081
(877) 778-9461
Mailing address
625 FAIR OAKS AVE STE 270, SOUTH PASADENA, CA 91030-5801
(626) 346-2455
(626) 639-3005

Taxonomy

Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
758758
CA
363L00000X
Nurse Practitioner
Primary
95008198
CA

Other

Enumeration date
08/23/2007
Last updated
07/12/2018
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