Provider Demographics
NPI:1710548698
Name:MARQUEZ MONTOYA, OCTAVIO (ATC)
Entity type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:
Last Name:MARQUEZ MONTOYA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 E 103RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-4903
Mailing Address - Country:US
Mailing Address - Phone:323-696-5418
Mailing Address - Fax:
Practice Address - Street 1:1200 ROSECRANS AVE STE 206
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2451
Practice Address - Country:US
Practice Address - Phone:310-726-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer