Provider Demographics
NPI:1093809592
Name:MONTES MEDICAL GROUP INC
Entity Type:Organization
Organization Name:MONTES MEDICAL GROUP INC
Other - Org Name:MONTES MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ZEPEDA
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-419-4354
Mailing Address - Street 1:832 S. GREVILLEA AVE.
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-3312
Mailing Address - Country:US
Mailing Address - Phone:310-419-4354
Mailing Address - Fax:310-419-4621
Practice Address - Street 1:832 S. GREVILLEA AVE.
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3312
Practice Address - Country:US
Practice Address - Phone:310-419-4354
Practice Address - Fax:310-419-4621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0026811Medicaid
CAA88354Medicare UPIN
CAGR0026811Medicaid
CAW10298AMedicare PIN
CAG82928Medicare UPIN