Provider Demographics
NPI:1053468314
Name:MONTALBO, YUNDELL H (PA)
Entity Type:Individual
Prefix:MS
First Name:YUNDELL
Middle Name:H
Last Name:MONTALBO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35581 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-6211
Mailing Address - Country:US
Mailing Address - Phone:951-318-3790
Mailing Address - Fax:951-849-0080
Practice Address - Street 1:330 W RAMSEY STREET
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220
Practice Address - Country:US
Practice Address - Phone:951-849-1950
Practice Address - Fax:951-849-0080
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14164363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical