Provider Demographics
NPI:1609072198
Name:MONTBRIAND, MICHAEL PHILLIP
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PHILLIP
Last Name:MONTBRIAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2265
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-2265
Mailing Address - Country:US
Mailing Address - Phone:530-666-8100
Mailing Address - Fax:530-666-6556
Practice Address - Street 1:624 COURT ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3426
Practice Address - Country:US
Practice Address - Phone:530-666-8100
Practice Address - Fax:530-666-6556
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator