Individual provider Active NPI

Tiffany Alpha Montes, NP

  • Nurse Practitioner
  • Fontana, CA
National Provider Identifier
1295384428
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95017406 Issued in CA
Practice address
7965 Sierra Ave Ste E
Fontana, CA 92336-3329
Phone
(909) 356-4459
Fax
(909) 355-4261
NPI assigned
Sep 10, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95017406 CA
Registered Nurse 163W00000X 845089 CA
Nurse Practitioner 363L00000X 95017406 CA Primary

Addresses

Primary practice location

7965 Sierra Ave Ste E
Fontana, CA 92336-3329

Mailing address

35972 Anderson St
Beaumont, CA 92223-7409

Other identifiers 2

IdentifierTypeStateIssuer
CA482046MedicaidCA
1295384428OtherCAMEDICAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210802000337 CA Practitioner - Nurse Practitioner 8022412824 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95017406CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
San Marcos Medical Group Inc CurrentSince Aug 2, 2021 Accepting new patients

Locations

7965 Sierra Ave
Ste E
Fontana, CA 92336
Phone (909) 356-4459

14980 Summit Ave
Ste 230
Fontana, CA 92336
Phone (909) 803-1160

1574 W Base Line St
Ste 107
Sn Bernrdno, CA 92411
Phone (909) 386-1880

742 W Highland Ave
Sn Bernrdno, CA 92405
Phone (909) 881-7320

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: tiffany.montes.p64@direct.mydohc.nextgenshare.com
  • Direct secure messaging: tiffany.montea.p1@direct.metro.nextgenshare.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1295384428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35972 ANDERSON ST",
            "city": "BEAUMONT",
            "state": "CA",
            "postal_code": "922237409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7965 SIERRA AVE STE E",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923363329",
            "telephone_number": "909-356-4459",
            "fax_number": "909-355-4261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTES",
        "first_name": "TIFFANY",
        "middle_name": "ALPHA",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-10",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95017406",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "845089",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95017406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CA482046",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "1295384428",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.