MEDICARE: ALEXIS MONTAVON BS

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	374J00000X	Doula	117016	OR

General Provider Information

NPI Number	:	1477490746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS MONTAVON BS

Provider Business Mailing Address
First Line	:	6340 SPERRY RD
Second Line	:
City	:	MOUNT HOOD PARKDALE
State	:	OR
Zip	:	97041-7639
Country	:	US
Telephone Number	:	541-806-4462
Fax Number	:

Provider Business Practice Location Address
First Line	:	2916 SE 18TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-2223
Country	:	US
Telephone Number	:	541-806-4462
Fax Number	:

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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