=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376736199
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA MONTANO LVN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2007
-----------------------------------------------------
Last Update Date | 08/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 N WESTERN AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-5615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-461-3131
-----------------------------------------------------
Fax | 323-957-7419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1325 N WESTERN AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-5615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-461-3131
-----------------------------------------------------
Fax | 323-957-7419
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | VN176540
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------