Healthcare Provider Details

I. General information

NPI: 1881464584
Provider Name (Legal Business Name): DALTON MONTOYA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 BUELL ST
OAKLAND CA
94619-2861
US

IV. Provider business mailing address

1146 KEY AVE
SAN FRANCISCO CA
94124-3560
US

V. Phone/Fax

Practice location:
  • Phone: 510-422-3959
  • Fax:
Mailing address:
  • Phone: 909-706-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: