Healthcare Provider Details

I. General information

NPI: 1407792450
Provider Name (Legal Business Name): LENNIN MONTALVO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 W BUCKEYE RD
PHOENIX AZ
85043-4700
US

IV. Provider business mailing address

6931 W ANTELOPE DR
PEORIA AZ
85383-6025
US

V. Phone/Fax

Practice location:
  • Phone: 602-233-2117
  • Fax:
Mailing address:
  • Phone: 661-970-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberRHP100914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: