Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PTA48560 | CA |
Y | 213ES0000X | Sports Medicine | PTA48560 | CA |
NPI | 1316511611 |
---|---|
Provider Name | Stephanie Montalban |
First Address | Valencia, CA 91355-1012 |
Second Address | Valencia, CA 91355-1012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2021 |
Last Update Date | 19/05/2021 |