=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366714321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVELIN M MONTOYA LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2012
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 323 N PRAIRIE AVE
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90301-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-677-7808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4952 N BRIGHTVIEW DR
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91722-2117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-985-8813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 127543
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------