Provider Demographics
NPI:1033929161
Name:MONTALVAN, BRITTANY R
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:R
Last Name:MONTALVAN
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 1:3463 CASTLE GLEN DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2414
Mailing Address - Country:US
Mailing Address - Phone:619-306-7524
Mailing Address - Fax:
Practice Address - Street 1:3463 CASTLE GLEN DR APT 1B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2414
Practice Address - Country:US
Practice Address - Phone:619-306-7524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77139225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty