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General NPI Number Information
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NPI Number | 1558508713
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Entity Type | Organization
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Legal Business Name | ANDREA MONTIJO
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 561 W MAIN ST
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City | EL CENTRO
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State | CA
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Zip | 92243-7917
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Country | US
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Telephone | 760-352-5582
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Fax |
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Provider Business Mailing Address
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Address Line | 561 W MAIN ST
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City | EL CENTRO
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State | CA
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Zip | 92243-7917
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Country | US
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Telephone | 760-352-5582
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA MONTIJO
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Credential |
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Telephone | 760-352-5582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT8074
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT10131
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License Number State | CA
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