| Luzviminda T Montecillo Md A Professional Corporation | |
|
645 Aerick Street Suite 1 Inglewood CA 90301-4882 | |
| (310) 673-2764 | |
| (310) 673-2403 |
| Full Name | Luzviminda T Montecillo Md A Professional Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 645 Aerick Street, Inglewood, California |
| Authorized Official Name and Position | Oscar Tagorda (OFFICE MANAGER) |
| Authorized Official Contact | 3106732764 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Luzviminda T Montecillo Md A Professional Corporation 645 Aerick St Ste 1 Inglewood CA 90301-4882 Ph: (310) 673-2764 | Luzviminda T Montecillo Md A Professional Corporation 645 Aerick Street Suite 1 Inglewood CA 90301-4882 Ph: (310) 673-2764 |
| NPI Number | 1285711812 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 03/18/2020 |
| Medicare PECOS PAC ID | 5092761585 |
|---|---|
| Medicare Enrollment ID | O20050328001010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285711812 | NPI | - | NPPES |
| 00A522900 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A52290 (California) | Primary |
| Provider Name | Luzviminda Montecillo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447348149 PECOS PAC ID: 9335112416 Enrollment ID: I20041102000453 |
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