Provider Demographics
NPI:1790543593
Name:MONTOYA, XOCHITL IXEL
Entity Type:Individual
Prefix:MISS
First Name:XOCHITL
Middle Name:IXEL
Last Name:MONTOYA
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 1:1224 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-2339
Mailing Address - Country:US
Mailing Address - Phone:909-572-9095
Mailing Address - Fax:
Practice Address - Street 1:1224 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-2339
Practice Address - Country:US
Practice Address - Phone:909-572-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician