Healthcare Provider Details

I. General information

NPI: 1487257028
Provider Name (Legal Business Name): YSEL MONTIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 OVERLAND AVE
LOS ANGELES CA
90034-6311
US

IV. Provider business mailing address

1328 2ND ST
SANTA MONICA CA
90401-1122
US

V. Phone/Fax

Practice location:
  • Phone: 310-394-6889
  • Fax:
Mailing address:
  • Phone: 310-394-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: