Healthcare Provider Details

I. General information

NPI: 1205715232
Provider Name (Legal Business Name): LUPITA REYES MONTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41307 12TH ST W
PALMDALE CA
93551-1445
US

IV. Provider business mailing address

41307 12TH ST W
PALMDALE CA
93551-1445
US

V. Phone/Fax

Practice location:
  • Phone: 661-575-8395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: