NPIMap

Organization Active NPI

Montecristo Medical PC

  • Primary Care Clinic/Center
  • Van Nuys, CA
National Provider Identifier
1699268631
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
A100277 Issued in CA
Legal business name
MONTECRISTO MEDICAL PC
Practice address
14649 Victory Blvd Ste 20
Van Nuys, CA 91411
Phone
(818) 786-8396
Fax
(818) 901-7128
NPI assigned
Jun 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Anita Emperatriz Gonzalez, MDNPI 1518161629
Title
President
Phone
(818) 568-6923

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X A100277 CA Primary

Addresses

Primary practice location

14649 Victory Blvd Ste 20
Van Nuys, CA 91411

Mailing address

14649 Victory Blvd Ste 20
Van Nuys, CA 91411-4101
Phone (818) 786-8396

Other practice location 1

14350 Victory Blvd Ste 3
Van Nuys, CA 91401-1994
Phone (818) 786-8396

Other practice location 2

14350 Victory Blvd Ste 3
Van Nuys, CA 91401-1994
Phone (818) 786-8396

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180813003328 CA Part B Supplier - Clinic/Group Practice 4082963772 Receives reassigned benefits from 3 practitioners
Practice locations: Van Nuys, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571788800000",
    "number": "1699268631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14649 VICTORY BLVD STE 20",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914114101",
            "telephone_number": "818-786-8396",
            "fax_number": "818-901-7128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14649 VICTORY BLVD STE 20",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "91411",
            "telephone_number": "818-786-8396",
            "fax_number": "818-901-7128"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14350 Victory Blvd Ste 3",
            "address_purpose": "LOCATION",
            "city": "Van Nuys",
            "state": "CA",
            "postal_code": "914011994",
            "country_code": "US",
            "telephone_number": "818-786-8396",
            "fax_number": "818-901-7128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14350 Victory Blvd Ste 3",
            "address_purpose": "LOCATION",
            "city": "Van Nuys",
            "state": "CA",
            "postal_code": "914011994",
            "country_code": "US",
            "telephone_number": "818-786-8396",
            "fax_number": "818-901-7128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MONTECRISTO MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-13",
        "last_updated": "2019-10-23",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ANITA",
        "authorized_official_middle_name": "EMPERATRIZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-568-6923",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A100277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.