Provider Demographics
NPI:1518777507
Name:MONTILUS, VENEL
Entity type:Individual
Prefix:
First Name:VENEL
Middle Name:
Last Name:MONTILUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 W THUNDERBIRD RD APT 2069
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-8603
Mailing Address - Country:US
Mailing Address - Phone:786-372-4123
Mailing Address - Fax:
Practice Address - Street 1:14820 N CAVE CREEK RD STE 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4951
Practice Address - Country:US
Practice Address - Phone:833-599-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001954-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty