Provider Demographics
NPI:1275212888
Name:MONTOYA, JULIA MARIE TIBAYAN
Entity Type:Individual
Prefix:
First Name:JULIA MARIE
Middle Name:TIBAYAN
Last Name:MONTOYA
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 1:432 N BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4301
Mailing Address - Country:US
Mailing Address - Phone:310-741-4596
Mailing Address - Fax:
Practice Address - Street 1:432 N BEDFORD DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4301
Practice Address - Country:US
Practice Address - Phone:310-741-4596
Practice Address - Fax:310-741-4597
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist