Provider Demographics
NPI:1124363940
Name:MONTAIGNE MANAGEMENT
Entity Type:Organization
Organization Name:MONTAIGNE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMEGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-274-8310
Mailing Address - Street 1:9190 W OLYMPIC BLVD
Mailing Address - Street 2:#406
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3540
Mailing Address - Country:US
Mailing Address - Phone:310-274-8310
Mailing Address - Fax:310-274-7025
Practice Address - Street 1:9242 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4659
Practice Address - Country:US
Practice Address - Phone:310-274-8310
Practice Address - Fax:310-274-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG719203207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACW421AMedicare UPIN