| Montecristo Medical PC | |
|
14649 Victory Blvd Ste 20 Van Nuys CA 91411 | |
| (818) 786-8396 | |
| (818) 901-7128 |
| Full Name | Montecristo Medical PC |
|---|---|
| Speciality | Clinic/Center |
| Location | 14649 Victory Blvd Ste 20, Van Nuys, California |
| Authorized Official Name and Position | Anita Emperatriz Gonzalez (PRESIDENT) |
| Authorized Official Contact | 8185686923 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Montecristo Medical PC 14649 Victory Blvd Ste 20 Van Nuys CA 91411-4101 Ph: (818) 786-8396 | Montecristo Medical PC 14649 Victory Blvd Ste 20 Van Nuys CA 91411 Ph: (818) 786-8396 |
| NPI Number | 1699268631 |
|---|---|
| Provider Enumeration Date | 06/13/2018 |
| Last Update Date | 10/23/2019 |
| Medicare PECOS PAC ID | 4082963772 |
|---|---|
| Medicare Enrollment ID | O20180813003328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699268631 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A100277 (California) | Primary |
| Provider Name | Anita Emperatriz Gonzalez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1518161629 PECOS PAC ID: 9032355169 Enrollment ID: I20130416000573 |
| Provider Name | Jennifer Pearl Krohn |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336395037 PECOS PAC ID: 5496121592 Enrollment ID: I20221014000452 |
| Provider Name | Adriana Cortez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1366934499 PECOS PAC ID: 0446725303 Enrollment ID: I20260408001060 |
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Philip H. Lee Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7136 Haskell Ave Ste 205, Van Nuys, CA 91406 Phone: 818-908-4086 |
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