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General NPI Number Information
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NPI Number | 1003724683
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Entity Type | Individual
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Provider Name | JACK MONTOYA MS
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Gender | Male
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 22579 DEBERRY STREET
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City | GRAND TERRACE
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State | CA
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Zip | 92313
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Country | US
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Telephone | 909-580-5022
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 VALENCIA DR
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City | COLTON
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State | CA
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Zip | 92324-1798
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Country | US
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Telephone | 909-580-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 37160
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License Number State | CA
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