Provider Demographics
NPI:1093855199
Name:MONTEBELLO ORTHOPEDIC MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:MONTEBELLO ORTHOPEDIC MEDICAL GROUP, INC.
Other - Org Name:LOS ANGELES ORTHOPEDIC MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:L
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-654-6899
Mailing Address - Street 1:6758 PASSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-3666
Mailing Address - Country:US
Mailing Address - Phone:562-654-6899
Mailing Address - Fax:562-654-6895
Practice Address - Street 1:6758 PASSONS BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3666
Practice Address - Country:US
Practice Address - Phone:562-654-6899
Practice Address - Fax:562-654-6895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066391 GR0066390Medicaid
CAWG24785AMedicare PIN
CAF81420Medicare UPIN
CAGR0066391 GR0066390Medicaid
CAA90892Medicare UPIN
CA0707670001Medicare NSC