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General NPI Number Information
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NPI Number | 1477760478
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Entity Type | Individual
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Provider Name | KIMBERLY MONTANDON LVN
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13 STEPHEN TERRACE
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-2633
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Country | US
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Telephone | 760-328-0233
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Fax |
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Provider Business Mailing Address
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Address Line | 18545 COUNTRY PINE RD
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City | PERRIS
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State | CA
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Zip | 92570-9052
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Country | US
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Telephone | 951-776-3031
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN220508
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License Number State | CA
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