Individual provider Active NPI

Claudia Montenegro, D.O.

  • Family Medicine Physician
  • San Diego, CA
National Provider Identifier
1376098251
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A18132 Issued in CA
Practice address
4060 Fairmount Ave
San Diego, CA 92105-1608
Phone
(619) 280-4213
Fax
(619) 795-9849
NPI assigned
Aug 19, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A18132 CA Primary

Addresses

Primary practice location

4060 Fairmount Ave
San Diego, CA 92105-1608

Mailing address

4060 Fairmount Ave
San Diego, CA 92105-1608
Phone (619) 280-4213

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220303001789 CA Practitioner - Family Practice 5496029357 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
20A18132CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
La Maestra Family Clinic, Inc. CurrentSince Nov 10, 2021 Accepting new patients
La Maestra Family Clinic, Inc. CurrentSince Nov 10, 2021 Accepting new patients
La Maestra Family Clinic, Inc. Current Accepting new patients

Locations

165 S 1st St
El Cajon, CA 92019
Phone (619) 312-0347

217 Highland Ave
National City, CA 91950
Phone (619) 280-4213

4171 Fairmount Ave
San Diego, CA 92105
Phone (619) 280-4213

4060 Fairmount Ave
San Diego, CA 92105
Phone (619) 255-9155

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: claudia.montenegro.p1@direct.lamaestra.nextgenshare.com

Organizations & group practices 3

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": "1471564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1376098251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608",
            "telephone_number": "619-280-4213",
            "fax_number": "619-795-9849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608",
            "telephone_number": "619-280-4213",
            "fax_number": "619-795-9849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTENEGRO",
        "first_name": "CLAUDIA",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-19",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A18132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.