Healthcare Provider Details

I. General information

NPI: 1427280502
Provider Name (Legal Business Name): MARTHA IRASEMA MONTESINOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14550 SHERMAN WAY
VAN NUYS CA
91405-2210
US

IV. Provider business mailing address

1323 EVITA PL
OXNARD CA
93030-2598
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4879
  • Fax: 818-997-1370
Mailing address:
  • Phone: 805-861-0972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: