Provider Demographics
NPI:1861676819
Name:MONTALVO, SANDRA MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 N CITADEL AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6766
Mailing Address - Country:US
Mailing Address - Phone:559-323-4754
Mailing Address - Fax:
Practice Address - Street 1:1179 N CITADEL AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6766
Practice Address - Country:US
Practice Address - Phone:559-323-4754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA684205163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse