Provider Demographics
NPI:1275845232
Name:MONTOYA, LEAH AGUIRRE (NURSE PRACTITIONER -)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:AGUIRRE
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER -
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47965
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-0965
Mailing Address - Country:US
Mailing Address - Phone:310-677-9400
Mailing Address - Fax:310-677-9402
Practice Address - Street 1:3451 W CENTURY BLVD
Practice Address - Street 2:SUITE #B-1
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-1227
Practice Address - Country:US
Practice Address - Phone:310-677-9400
Practice Address - Fax:310-677-9402
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569588163W00000X
CA19245363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse