Provider Demographics
NPI:1588627178
Name:MONTEGRANDE, FAYE M (MD)
Entity Type:Individual
Prefix:DR
First Name:FAYE
Middle Name:M
Last Name:MONTEGRANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:321 N LARCHMONT BLVD
Mailing Address - Street 2:SUITE 824
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3025
Mailing Address - Country:US
Mailing Address - Phone:323-464-0286
Mailing Address - Fax:323-464-2635
Practice Address - Street 1:321 N LARCHMONT BLVD
Practice Address - Street 2:SUITE 824
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3025
Practice Address - Country:US
Practice Address - Phone:323-464-0286
Practice Address - Fax:323-464-2635
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA35388207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88335Medicare UPIN