MEDICARE: DR. JOSE NIVARDO MONTANO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A33055	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659343663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE NIVARDO MONTANO MD

Provider Business Mailing Address
First Line	:	3617 EAST M L KING JR BLVD
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262
Country	:	US
Telephone Number	:	310-638-1171
Fax Number	:	310-638-3715

Provider Business Practice Location Address
First Line	:	3617 EAST M L KING JR BLVD
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262
Country	:	US
Telephone Number	:	310-638-1171
Fax Number	:	310-638-3715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	07/08/2007

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