Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036.117542 | IL |
Y | 111NI0900X | Internist | 036.117542 | IL |
N | 207R00000X | Internist | C171520 | CA |
N | 111NI0900X | Internist | C171520 | CA |
N | 207RH0002X | Hospice and Palliative Medicine | 01077587A | IN |
N | 207RH0002X | Hospice and Palliative Medicine | 04-40201 | KS |
N | 207RH0002X | Hospice and Palliative Medicine | 2017023779 | MO |
NPI | 1346467941 |
---|---|
Provider Name | Dr. Jessica Ann Montalvo |
First Address | Chicago, IL 60657 |
Second Address | Chicago, IL 60611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 16/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C171520 | STATE LICENSE (01) | CA |