Provider Demographics
NPI:1538271457
Name:MONTE VP LLC
Entity type:Organization
Organization Name:MONTE VP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYROLLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-750-9207
Mailing Address - Street 1:9635 MONTE VISTA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2235
Mailing Address - Country:US
Mailing Address - Phone:909-624-9633
Mailing Address - Fax:909-624-9483
Practice Address - Street 1:9635 MONTE VISTA AVE STE 202
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2235
Practice Address - Country:US
Practice Address - Phone:909-624-9633
Practice Address - Fax:909-624-9483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X, 3336S0011X, 3336C0003X
CAPHY373943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
7991760001OtherMEDICARE DME PTAN
CA1538271457Medicaid
CA514431OtherMEDICARE NORIDIAN PTAN MASS IMMUNIZATION ROSTER BILLER
CA1538271457Medicaid