Provider Demographics
NPI:1427079136
Name:MONTLLOR, MICHELE M (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:M
Last Name:MONTLLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:470 COLUMBIA CIR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3306
Mailing Address - Country:US
Mailing Address - Phone:626-252-6242
Mailing Address - Fax:626-441-1048
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:PASADENA
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:626-397-5000
Practice Address - Fax:626-441-1048
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA034090208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A340900Medicaid
CAA84566Medicare UPIN
CA00A340900Medicaid