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General NPI Number Information
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NPI Number | 1053468314
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Entity Type | Individual
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Provider Name | YUNDELL H MONTALBO PA
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 330 W RAMSEY STREET
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City | BANNING
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State | CA
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Zip | 92220
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Country | US
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Telephone | 951-849-1950
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Fax | 951-849-0080
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Provider Business Mailing Address
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Address Line | 35581 STOCKTON ST
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City | BEAUMONT
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State | CA
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Zip | 92223-6211
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Country | US
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Telephone | 951-318-3790
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Fax | 951-849-0080
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA14164
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License Number State | CA
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