Provider Demographics
NPI:1477788529
Name:MONTEZ, LACHELE DENYSE (NP)
Entity Type:Individual
Prefix:
First Name:LACHELE
Middle Name:DENYSE
Last Name:MONTEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 W. OLYMPIC BLVD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4633
Mailing Address - Country:US
Mailing Address - Phone:323-935-5858
Mailing Address - Fax:323-935-1212
Practice Address - Street 1:5901 W. OLYMPIC BLVD
Practice Address - Street 2:SUITE 504
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4633
Practice Address - Country:US
Practice Address - Phone:323-935-5858
Practice Address - Fax:323-935-1212
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA609993363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner