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General NPI Number Information
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NPI Number | 1356725899
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Entity Type | Organization
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Legal Business Name | DOWNEY LASER INSTITUTE, INC.
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 2007 WILSHIRE BLVD STE 522
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City | LOS ANGELES
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State | CA
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Zip | 90057-3506
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Country | US
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Telephone | 213-805-6005
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Fax | 213-805-6001
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Provider Business Mailing Address
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Address Line | 10642 DOWNEY AVE STE 205
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City | DOWNEY
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State | CA
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Zip | 90241-3442
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CARLOS F MONTOYA SR.
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Credential | M.D.
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Telephone | 714-393-8809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A40547
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License Number State | CA
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