Provider Demographics
NPI:1114366630
Name:MONTGOMERY, MARINA JENA (CERTIFIED PHT)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:JENA
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CERTIFIED PHT
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:JENA
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6666 GREEN VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7068
Mailing Address - Country:US
Mailing Address - Phone:310-846-5270
Mailing Address - Fax:
Practice Address - Street 1:6666 GREEN VALLEY CIR
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7068
Practice Address - Country:US
Practice Address - Phone:310-846-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator