1538598438 NPI number — MS. MICHELLE JOANN MONTOYA M.A.

Table of content: MS. MICHELLE JOANN MONTOYA M.A. (NPI 1538598438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538598438 NPI number — MS. MICHELLE JOANN MONTOYA M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTOYA
Provider First Name:
MICHELLE
Provider Middle Name:
JOANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTOYA
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
JOANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538598438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14261 GRUEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91331-5349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-254-7086
Provider Business Mailing Address Fax Number:
661-254-7108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12754 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SET D
Provider Business Practice Location Address City Name:
STUDIO CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91604-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-308-6226
Provider Business Practice Location Address Fax Number:
818-308-6487
Provider Enumeration Date:
11/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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