Provider Demographics
NPI:1760540959
Name:YAMAT, SANDRA MONTANO (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MONTANO
Last Name:YAMAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:T
Other - Last Name:MONTANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7424 BRIDGEPORT WAY WEST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8137
Mailing Address - Country:US
Mailing Address - Phone:253-581-2111
Mailing Address - Fax:253-581-2712
Practice Address - Street 1:7424 BRIDGEPORT WAY WEST
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8137
Practice Address - Country:US
Practice Address - Phone:253-581-2111
Practice Address - Fax:253-581-2712
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60025230208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8521940Medicaid
F37922Medicare UPIN