Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 31647 | CA |
Y | 103T00000X | Psychologist | 31647 | CA |
NPI | 1003421256 |
---|---|
Provider Name | Dr. Jessica Lynette Montoya |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 28/10/2020 |