MEDICARE: JUAN MONTEMAYOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	16469	CA

General Provider Information

NPI Number	:	1083255483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN MONTEMAYOR

Provider Business Mailing Address
First Line	:	41555 COOK ST STE 100
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-5184
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 E TACHEVAH DR STE 107
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7402
Country	:	US
Telephone Number	:	760-459-0003
Fax Number	:	760-656-0614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	02/19/2020

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Directions to “ JUAN MONTEMAYOR ” Practice Location

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