Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 4301075789 | MI |
N | 207K00000X | Allergist & Immunologist | 66467 | MN |
N | 207KA0200X | Allergist | 4301075789 | MI |
N | 208000000X | Pediatrician | 4301075789 | MI |
Y | 208000000X | Pediatrician | 66467 | MN |
N | 208000000X | Pediatrician | 75082 | WI |
NPI | 1053358655 |
---|---|
Provider Name | Jenny Maribel Montejo |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 07/05/2021 |