Healthcare Provider Details

I. General information

NPI: 1225903941
Provider Name (Legal Business Name): MRS. CARMELLEE OLIVIA MONTILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 1ST ST
NAPA CA
94559-2239
US

IV. Provider business mailing address

6925 RIO TEJO WAY
ELK GROVE CA
95757-3433
US

V. Phone/Fax

Practice location:
  • Phone: 707-224-8266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: