Healthcare Provider Details

I. General information

NPI: 1457802068
Provider Name (Legal Business Name): ANDREA MONTOYA BRACKETT PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA BARCELONA MONTOYA

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CAMINO DIABLO STE 300
WALNUT CREEK CA
94597-4001
US

IV. Provider business mailing address

2970 CAMINO DIABLO STE 300
WALNUT CREEK CA
94597-4001
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone: 925-282-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number801279
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95005983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: