MEDICARE: DR. SANDRA MONTANO YAMAT M.D.

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	208000000X	Pediatrics Physician	MD60025230	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760540959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA MONTANO YAMAT M.D.

Provider Business Mailing Address
First Line	:	7424 BRIDGEPORT WAY WEST
Second Line	:	SUITE 103
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-8137
Country	:	US
Telephone Number	:	253-581-2111
Fax Number	:	253-581-2712

Provider Business Practice Location Address
First Line	:	7424 BRIDGEPORT WAY WEST
Second Line	:	SUITE 103
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-8137
Country	:	US
Telephone Number	:	253-581-2111
Fax Number	:	253-581-2712

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	09/05/2013

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