MEDICARE: MR. GONZALO MONTALVAN M.D.

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	173000000X	Legal Medicine	A40568	CA

General Provider Information

NPI Number	:	1851336127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GONZALO MONTALVAN M.D.

Provider Business Mailing Address
First Line	:	3815 ATLANTIC AVE
Second Line	:	STE 3
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3500
Country	:	US
Telephone Number	:	562-426-9482
Fax Number	:	562-424-1743

Provider Business Practice Location Address
First Line	:	3815 ATLANTIC AVE
Second Line	:	STE 3
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3500
Country	:	US
Telephone Number	:	562-426-9482
Fax Number	:	562-424-1743

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	01/31/2011

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