Healthcare Provider Details

I. General information

NPI: 1285567719
Provider Name (Legal Business Name): MRS. MARIE ANTOINETTE MONTEMAYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 BAKER ST
COALINGA CA
93210-1546
US

IV. Provider business mailing address

1111 VAN NESS AVE
FRESNO CA
93721-2002
US

V. Phone/Fax

Practice location:
  • Phone: 559-935-7500
  • Fax:
Mailing address:
  • Phone: 559-265-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW125362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: