MEDICARE: MONTES MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208000000X	Pediatrics Physician
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1437487956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTES MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	4545 E 3RD ST
Second Line	:	#102
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1656
Country	:	US
Telephone Number	:	323-266-7888
Fax Number	:	323-266-7997

Provider Business Practice Location Address
First Line	:	4545 E 3RD ST
Second Line	:	#102
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1656
Country	:	US
Telephone Number	:	323-266-7888
Fax Number	:	323-266-7997

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUAN ZEPEDA MONTES
Credential	:	M.D.
Telephone Number	:	562-205-3404

Provider Enumeration Date	:	11/20/2009
Last Update Date	:	05/21/2015

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