Healthcare Provider Details

I. General information

NPI: 1114778453
Provider Name (Legal Business Name): JOHANNA S MONTESINOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W SUNSET BLVD FL 5
LOS ANGELES CA
90027-6082
US

IV. Provider business mailing address

4700 W SUNSET BLVD FL 5
LOS ANGELES CA
90027-6082
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-2600
  • Fax:
Mailing address:
  • Phone: 323-783-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT145018
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC16045
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: