Healthcare Provider Details

I. General information

NPI: 1427756659
Provider Name (Legal Business Name): MONTARE NEURO CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17167 VENTURA BLVD # 300
ENCINO CA
91316-4004
US

IV. Provider business mailing address

203 S ORANGE DR
LOS ANGELES CA
90036-3010
US

V. Phone/Fax

Practice location:
  • Phone: 408-591-1397
  • Fax: 805-830-1565
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOANN ZUNIGA
Title or Position: DIRECTOR
Credential:
Phone: 408-591-1397