Provider Demographics
NPI:1053657791
Name:MONTEON, WENDY CAROLINE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:CAROLINE
Last Name:MONTEON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1104
Mailing Address - Country:US
Mailing Address - Phone:323-730-1920
Mailing Address - Fax:323-730-1820
Practice Address - Street 1:3834 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1104
Practice Address - Country:US
Practice Address - Phone:323-730-1920
Practice Address - Fax:323-730-1820
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant