Provider Demographics
NPI:1265656854
Name:MONTES, CONNIE D (PAC PHYSICIAN ASSIST)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:D
Last Name:MONTES
Suffix:
Gender:F
Credentials:PAC PHYSICIAN ASSIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14609 E WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605
Mailing Address - Country:US
Mailing Address - Phone:562-789-9592
Mailing Address - Fax:562-789-6102
Practice Address - Street 1:14609 E WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605
Practice Address - Country:US
Practice Address - Phone:562-789-9592
Practice Address - Fax:562-789-6102
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13711363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant