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1912008558 NPI number — MR. JORGE JAVIER MONTOYA

NPI Number: 1912008558
Health Care Provider/Practitioner: MR. JORGE JAVIER MONTOYA

Information about “1912008558” NPI (MR. JORGE JAVIER MONTOYA) exists in 1912008558 in HTML format HTML  |  1912008558 in plain Text format TXT  |  1912008558 in PDF (Portable Document Format) PDF  |  1912008558 in an XML format XML  formats.

NPI Number : 1912008558 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912008558",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MONTOYA",
    "FirstName": "JORGE",
    "MiddleName": "JAVIER",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3441 E CALLE BAJA DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST COVINA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91792-2906",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-595-5293",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "211 W COMMONWEALTH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FULLERTON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92832-1810",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-447-7099",
    "PracticeLocationAddressFaxNumber": "714-447-7015",
    "EnumerationDate": "09/26/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "IMF41368",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "IMF41368",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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