MEDICARE: HAILEY S MONTESINOS

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1205761962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY S MONTESINOS

Provider Business Mailing Address
First Line	:	11330 ELKWOOD ST
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-4439
Country	:	US
Telephone Number	:	323-303-6078
Fax Number	:	818-527-2326

Provider Business Practice Location Address
First Line	:	500 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3540
Country	:	US
Telephone Number	:	323-303-6078
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ HAILEY S MONTESINOS ” Practice Location

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