Provider Demographics
NPI:1104021518
Name:TAJON, MANUEL MONTOYA (PSYD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:MONTOYA
Last Name:TAJON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 WOODMERE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-3862
Mailing Address - Country:US
Mailing Address - Phone:805-218-8165
Mailing Address - Fax:
Practice Address - Street 1:2615 S MILLER ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1775
Practice Address - Country:US
Practice Address - Phone:805-319-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service