Healthcare Provider Details

I. General information

NPI: 1376011544
Provider Name (Legal Business Name): WENDY HANAI MONTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 MT DIABLO BLVD STE 107
LAFAYETTE CA
94549-3768
US

IV. Provider business mailing address

1930 87TH AVE
OAKLAND CA
94621-1518
US

V. Phone/Fax

Practice location:
  • Phone: 866-523-4268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: