Provider Demographics
NPI:1518224450
Name:MONTES, LUCRESIA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCRESIA
Middle Name:MARIA
Last Name:MONTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 WESTBOURNE DR REAR
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1913
Mailing Address - Country:US
Mailing Address - Phone:310-925-8449
Mailing Address - Fax:323-591-5029
Practice Address - Street 1:565 WESTBOURNE DR REAR
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1913
Practice Address - Country:US
Practice Address - Phone:310-925-8449
Practice Address - Fax:323-591-5029
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA154373207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program