Provider Demographics
NPI:1053438309
Name:MONTEZ, MICHAEL LAWRENCE (MS, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:MONTEZ
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:4317 E 4TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-0952
Mailing Address - Country:US
Mailing Address - Phone:562-930-9049
Mailing Address - Fax:323-442-8750
Practice Address - Street 1:1500 SAN PABLO ST.
Practice Address - Street 2:USC UNIVERSITY HOSPITAL SPORTS MED.
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-442-5226
Practice Address - Fax:323-442-8750
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA020421422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer