Provider Demographics
NPI:1831906098
Name:LEYVA MONTANEZ, FATIMA
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:LEYVA MONTANEZ
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 MONTGOMERY DR APT 22
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-5293
Mailing Address - Country:US
Mailing Address - Phone:707-478-3752
Mailing Address - Fax:
Practice Address - Street 1:2227 CAPRICORN WAY STE 207208
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5478
Practice Address - Country:US
Practice Address - Phone:707-565-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker