Healthcare Provider Details

I. General information

NPI: 1053271411
Provider Name (Legal Business Name): AYANNA MONTALVO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N DEWITT AVE STE 220
CLOVIS CA
93612-1066
US

IV. Provider business mailing address

1333 S MAYFLOWER AVE STE 220
MONROVIA CA
91016-5239
US

V. Phone/Fax

Practice location:
  • Phone: 559-477-5546
  • Fax:
Mailing address:
  • Phone: 818-241-6780
  • Fax: 888-588-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberY7958069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: