Provider Demographics
NPI:1235869637
Name:MONTANO, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MONTANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 S MARIPOSA AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3233
Mailing Address - Country:US
Mailing Address - Phone:213-858-1543
Mailing Address - Fax:
Practice Address - Street 1:5628 E SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2922
Practice Address - Country:US
Practice Address - Phone:323-318-9960
Practice Address - Fax:323-780-3211
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL