Provider Demographics
NPI:1982873162
Name:MONTES MEDICAL GROUP INC
Entity Type:Organization
Organization Name:MONTES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ZEPEDA
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-419-4354
Mailing Address - Street 1:11822 FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-2900
Mailing Address - Country:US
Mailing Address - Phone:562-908-4355
Mailing Address - Fax:156-290-8436
Practice Address - Street 1:11822 FLORAL DR
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-2900
Practice Address - Country:US
Practice Address - Phone:562-908-4355
Practice Address - Fax:156-290-8436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64056207Q00000X
CAG35182207R00000X, 207RA0401X
CAA35815208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0026810Medicaid
CAW10298Medicare PIN
CAA88354Medicare UPIN
CAA89596Medicare UPIN
CAG82928Medicare UPIN