Provider Demographics
NPI:1235841693
Name:MONREAL, EZRA GISSEL
Entity Type:Individual
Prefix:
First Name:EZRA
Middle Name:GISSEL
Last Name:MONREAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ELVIA
Other - Middle Name:G
Other - Last Name:BENAVIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RCP
Mailing Address - Street 1:109 S MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2839
Mailing Address - Country:US
Mailing Address - Phone:310-531-6010
Mailing Address - Fax:
Practice Address - Street 1:10833 LA CONTE AVE 22-387 MDCC
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-0867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37003227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered