Provider Demographics
NPI:1447348149
Name:MONTECILLO, LUZVIMINDA T (MD)
Entity type:Individual
Prefix:DR
First Name:LUZVIMINDA
Middle Name:T
Last Name:MONTECILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:719 HIGH LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-5107
Mailing Address - Country:US
Mailing Address - Phone:310-673-2764
Mailing Address - Fax:310-673-2403
Practice Address - Street 1:645 AERICK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4881
Practice Address - Country:US
Practice Address - Phone:310-673-2764
Practice Address - Fax:310-673-2403
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA52290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A522900Medicaid
CAG13044Medicare UPIN
CAG13044Medicare UPIN