Provider Demographics
NPI:1780728923
Name:GORES, MONTE SCOTT (MS, DAOM, LAC)
Entity type:Individual
Prefix:
First Name:MONTE
Middle Name:SCOTT
Last Name:GORES
Suffix:
Gender:M
Credentials:MS, DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4044
Mailing Address - Country:US
Mailing Address - Phone:928-600-0397
Mailing Address - Fax:
Practice Address - Street 1:3622 TEXAS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-4044
Practice Address - Country:US
Practice Address - Phone:928-600-0397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1061321OtherACUPUNCTURIST (ASH)
CA1062445OtherMASSAGE THERAPIST (ASH)