Healthcare Provider Details

I. General information

NPI: 1093636250
Provider Name (Legal Business Name): JULIEANNA SHAREY MONTANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5858 MORGAN PL APT 81
STOCKTON CA
95219-4629
US

IV. Provider business mailing address

1111 W TOKAY ST
LODI CA
95240-3965
US

V. Phone/Fax

Practice location:
  • Phone: 702-881-1703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: