Healthcare Provider Details

I. General information

NPI: 1033390943
Provider Name (Legal Business Name): ADRIANA LANIZA MONTELLANO NATIVIDAD CERTIFIED OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 DEL AMO BLVD
TORRANCE CA
90503-1637
US

IV. Provider business mailing address

PO BOX 6900
TORRANCE CA
90504-0100
US

V. Phone/Fax

Practice location:
  • Phone: 310-214-0811
  • Fax: 310-793-4658
Mailing address:
  • Phone: 310-214-0811
  • Fax: 310-793-4658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number162631
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number162631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: