Provider Demographics
NPI:1376264903
Name:MONTERO, MANUEL LUIS (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:LUIS
Last Name:MONTERO
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25241 LA MAR RD APT B
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3021
Mailing Address - Country:US
Mailing Address - Phone:787-509-0316
Mailing Address - Fax:
Practice Address - Street 1:25241 LA MAR RD APT B
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3021
Practice Address - Country:US
Practice Address - Phone:787-509-0316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program