Provider Demographics
NPI:1750666855
Name:MONTEJANO, HEAVEN DESTINY
Entity Type:Individual
Prefix:
First Name:HEAVEN
Middle Name:DESTINY
Last Name:MONTEJANO
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 1:17285 MARKROSS CT APT 1
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4686
Mailing Address - Country:US
Mailing Address - Phone:408-722-2448
Mailing Address - Fax:
Practice Address - Street 1:17285 MARKROSS CT APT 1
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4686
Practice Address - Country:US
Practice Address - Phone:408-722-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist