Provider Demographics
NPI:1063420974
Name:MONTOYA, CARLOS F (MD)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:F
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2746 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5747
Mailing Address - Country:US
Mailing Address - Phone:323-583-4567
Mailing Address - Fax:323-583-4560
Practice Address - Street 1:2746 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5747
Practice Address - Country:US
Practice Address - Phone:323-583-4567
Practice Address - Fax:323-583-4560
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40547208D00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092651Medicaid
A85466Medicare UPIN
W16796Medicare ID - Type Unspecified
CAGR0092651Medicaid