Provider Demographics
NPI:1164048864
Name:MONTANO, PAULA YEDITH
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:YEDITH
Last Name:MONTANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1906
Mailing Address - Country:US
Mailing Address - Phone:626-480-8107
Mailing Address - Fax:
Practice Address - Street 1:17229 VILLA PARK ST
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-5037
Practice Address - Country:US
Practice Address - Phone:626-407-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician