Healthcare Provider Details

I. General information

NPI: 1033818174
Provider Name (Legal Business Name): IVONE SARAI MONTIJO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ANDRADE AVE APT C
CALEXICO CA
92231-3075
US

IV. Provider business mailing address

120 ANDRADE AVE APT C
CALEXICO CA
92231-3075
US

V. Phone/Fax

Practice location:
  • Phone: 760-235-8137
  • Fax:
Mailing address:
  • Phone: 760-235-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: