Healthcare Provider Details

I. General information

NPI: 1548322217
Provider Name (Legal Business Name): THOMAS MONTELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 TORRANCE BLVD STE F
TORRANCE CA
90503-5800
US

IV. Provider business mailing address

3475 TORRANCE BLVD STE F
TORRANCE CA
90503-5800
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-5455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG56829
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberG56829
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG56829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: