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General NPI Number Information
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NPI Number | 1699783506
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Entity Type | Organization
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Legal Business Name | ST LUCIA EYE CENTER MEDICAL CORP
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 2746 E FLORENCE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-5747
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Country | US
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Telephone | 323-583-4567
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Fax | 323-583-4560
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Provider Business Mailing Address
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Address Line | 2746 E FLORENCE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-5747
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Country | US
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Telephone | 323-583-4567
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Fax | 323-583-4560
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CARLOS F MONTOYA JR.
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Credential | MD
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Telephone | 323-583-4567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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