Provider Demographics
NPI:1366970832
Name:TAVAKKOLI, MONTREH (MD)
Entity type:Individual
Prefix:
First Name:MONTREH
Middle Name:
Last Name:TAVAKKOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W HELLMAN AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1209
Mailing Address - Country:US
Mailing Address - Phone:310-400-0645
Mailing Address - Fax:424-270-6232
Practice Address - Street 1:120 W HELLMAN AVE STE 303
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1209
Practice Address - Country:US
Practice Address - Phone:310-400-0645
Practice Address - Fax:424-270-6232
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA197460207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology