Healthcare Provider Details

I. General information

NPI: 1851013015
Provider Name (Legal Business Name): BERENICE MONTOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

47915 OASIS ST
INDIO CA
92201-6950
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number763417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: