Provider Demographics
NPI:1538302971
Name:MONTI, JULANA (MD)
Entity Type:Individual
Prefix:
First Name:JULANA
Middle Name:
Last Name:MONTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULANA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-0119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:318-939-6861
Practice Address - Street 1:672 BERT KOUNS LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-5701
Practice Address - Country:US
Practice Address - Phone:318-347-7290
Practice Address - Fax:318-949-6861
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204019208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice