Healthcare Provider Details

I. General information

NPI: 1063420974
Provider Name (Legal Business Name): CARLOS F MONTOYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2746 E FLORENCE AVE
HUNTINGTON PARK CA
90255-5747
US

IV. Provider business mailing address

2746 E FLORENCE AVE
HUNTINGTON PARK CA
90255-5747
US

V. Phone/Fax

Practice location:
  • Phone: 323-583-4567
  • Fax: 323-583-4560
Mailing address:
  • Phone: 323-583-4567
  • Fax: 323-583-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA40547
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA40547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: