Healthcare Provider Details

I. General information

NPI: 1043143811
Provider Name (Legal Business Name): PAOLA MONTOYA WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E ALOSTA AVE
AZUSA CA
91702-3102
US

IV. Provider business mailing address

777 E ALOSTA AVE
AZUSA CA
91702-3102
US

V. Phone/Fax

Practice location:
  • Phone: 626-508-0713
  • Fax:
Mailing address:
  • Phone: 626-508-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number148717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: