Healthcare Provider Details

I. General information

NPI: 1417732926
Provider Name (Legal Business Name): RONALD MONTOYA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4862 E CLINTON AVE
FRESNO CA
93703-2873
US

IV. Provider business mailing address

4862 E CLINTON AVE
FRESNO CA
93703-2873
US

V. Phone/Fax

Practice location:
  • Phone: 559-252-2450
  • Fax:
Mailing address:
  • Phone: 559-446-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number116908
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: