Provider Demographics
NPI:1447234208
Name:MONTILLANO, MARVIN BARRIENTOS (MPT)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:BARRIENTOS
Last Name:MONTILLANO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39252 WINCHESTER RD STE 107-115
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3509
Mailing Address - Country:US
Mailing Address - Phone:951-704-2215
Mailing Address - Fax:951-302-5214
Practice Address - Street 1:31309 TEMECULA PKWY STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6826
Practice Address - Country:US
Practice Address - Phone:951-302-5213
Practice Address - Fax:951-302-5214
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT270010OtherBLUE SHIELD OF CALIFORNIA
CA0PT270010OtherBLUE SHIELD OF CALIFORNIA
CAOPT270010OtherBLUE SHIELD