Provider Demographics
NPI:1245519537
Name:MONTGOMERY, MICHELLE MARCINE
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARCINE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 E PACIFIC COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-5729
Mailing Address - Country:US
Mailing Address - Phone:562-279-3633
Mailing Address - Fax:310-631-6915
Practice Address - Street 1:2939 E PACIFIC COMMERCE DR
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-5729
Practice Address - Country:US
Practice Address - Phone:562-279-3633
Practice Address - Fax:310-631-6915
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker