MEDICARE: ELSY MONTANO

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	172V00000X	Community Health Worker		CA

General Provider Information

NPI Number	:	1942682349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSY MONTANO

Provider Business Mailing Address
First Line	:	1120 W LA VETA AVE STE. 660
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4231
Country	:	US
Telephone Number	:	714-509-8210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 W LA VETA AVE STE 660, 470
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4244
Country	:	US
Telephone Number	:	714-509-8210
Fax Number	:	714-509-8211

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

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	11/14/2023

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Directions to “ ELSY MONTANO ” Practice Location

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