Provider Demographics
NPI:1144665100
Name:MOUNTAIN GROUP LLC
Entity type:Organization
Organization Name:MOUNTAIN GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:818-415-7254
Mailing Address - Street 1:931 BUENA VISTA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1712
Mailing Address - Country:US
Mailing Address - Phone:626-531-6891
Mailing Address - Fax:626-531-6890
Practice Address - Street 1:931 BUENA VISTA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1712
Practice Address - Country:US
Practice Address - Phone:626-531-6891
Practice Address - Fax:626-531-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-05
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic