Doctor Name: | DR. BLAINE L MONTGOMERY |
NPI Number: | 1194939884 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A28710 |
Business Practice Address: | 927 Deep Valley Dr Suite 160 Rolling Hills Estates, CA - 902743808 |
Business Phone Number: | 3105414406 |
Business Fax Number: | 3105414074 |
Mailing Address: | 6833 Abbottswood Dr, RANCHO PALOS VERDES |
State: | CA |
Postal Code: | 902753058 |
Phone Number: | 3103772635 |
Fax Number: | |
NPI Enumeration Date: | 05/10/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | A28710 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |