Provider Demographics
NPI:1790442846
Name:MARVIN MONTILLANO
Entity Type:Organization
Organization Name:MARVIN MONTILLANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTILLANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:951-704-2215
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty