Healthcare Provider Details

I. General information

NPI: 1427079136
Provider Name (Legal Business Name): MICHELE M MONTLLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD PASADENA
PASADENA CA
91105-3010
US

IV. Provider business mailing address

470 COLUMBIA CIR
PASADENA CA
91105-3306
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5000
  • Fax: 626-441-1048
Mailing address:
  • Phone: 626-252-6242
  • Fax: 626-441-1048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA034090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: