Healthcare Provider Details

I. General information

NPI: 1093809592
Provider Name (Legal Business Name): MONTES MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 S. GREVILLEA AVE.
INGLEWOOD CA
90301-3312
US

IV. Provider business mailing address

832 S. GREVILLEA AVE.
INGLEWOOD CA
90301-3312
US

V. Phone/Fax

Practice location:
  • Phone: 310-419-4354
  • Fax: 310-419-4621
Mailing address:
  • Phone: 310-419-4354
  • Fax: 310-419-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN ZEPEDA MONTES
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-419-4354