=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598019754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIO A. MONTANO, MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2012
-----------------------------------------------------
Last Update Date | 11/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 234 E BADILLO ST
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91723-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-915-9992
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2206 S 8TH AVE
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91006-5433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-484-9394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JULIO ALBERTO MONTANO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 626-484-9394
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A64835
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------