Provider Demographics
NPI:1306206958
Name:MONTIJO, MARIA JOSE (LAC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSE
Last Name:MONTIJO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 DAMUTH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2447
Mailing Address - Country:US
Mailing Address - Phone:510-361-7255
Mailing Address - Fax:
Practice Address - Street 1:2939 SUMMIT ST STE 301
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3404
Practice Address - Country:US
Practice Address - Phone:510-788-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16892171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist