MEDICARE: ISLAY MONTIEL-ESTRADA RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1326610718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISLAY MONTIEL-ESTRADA RBT

Provider Business Mailing Address
First Line	:	1438 N HIGHWAY 89 STE 130
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-2737
Country	:	US
Telephone Number	:	801-200-1444
Fax Number	:	801-513-5608

Provider Business Practice Location Address
First Line	:	1438 N HIGHWAY 89 STE 130
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-2737
Country	:	US
Telephone Number	:	801-200-1444
Fax Number	:	801-513-5608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	01/30/2023

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Directions to “ ISLAY MONTIEL-ESTRADA RBT” Practice Location

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