Maria Lydia Montenegro, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD00021239 Issued in WA

Practice address

2320 Salnave Rd
Lakeland Village
Medical Lake, WA 99022

Phone

(509) 299-1836

Fax

(509) 299-1906

NPI assigned

Feb 28, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619005014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 SALNAVE RD",
            "address_2": "LAKELAND VILLAGE",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "99022",
            "telephone_number": "509-299-1836",
            "fax_number": "509-299-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 SALNAVE RD",
            "address_2": "LAKELAND VILLAGE",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "99022",
            "telephone_number": "509-299-1836",
            "fax_number": "509-299-1906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTENEGRO",
        "first_name": "MARIA LYDIA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "MD00021239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1056597",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erika Dawn Miller, PHARMD
• Mary Kay Miller
• Celina Emily Mitchell
• Jennifer Mitchell, PHARM.D.
• Fereshteh Momeni, M.D.
• Paul D Morrison, MD
• Teresiah Mugi
• Natural Health Ctr of Med Lake PS
• Averly H Nelson, M.D.
• Connie Nelson

• General Practice Physician in Medical Lake, WA
• Providers in Medical Lake, WA by specialty
• General Practice Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.