Healthcare Provider Details

I. General information

NPI: 1972236149
Provider Name (Legal Business Name): MELISSA MONTALVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 IMPERIAL HWY
NORWALK CA
90650-3179
US

IV. Provider business mailing address

3569 LEXINGTON AVE
EL MONTE CA
91731-2607
US

V. Phone/Fax

Practice location:
  • Phone: 562-807-6100
  • Fax:
Mailing address:
  • Phone: 626-453-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW115631
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW115631
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: