Healthcare Provider Details

I. General information

NPI: 1306072053
Provider Name (Legal Business Name): ANAHI MONTOYA LUNA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E. COLORADO BLVD., SUITE 100
PASADENA CA
91107-6622
US

IV. Provider business mailing address

4024 DURFEE AVE
EL MONTE CA
91732-2510
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-2261
  • Fax:
Mailing address:
  • Phone: 626-455-4639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW69249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: