Provider Demographics
NPI:1114350873
Name:MONTALLANA, KHRYSTLE
Entity type:Individual
Prefix:
First Name:KHRYSTLE
Middle Name:
Last Name:MONTALLANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29511 DANA CT
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-7102
Mailing Address - Country:US
Mailing Address - Phone:213-505-2348
Mailing Address - Fax:
Practice Address - Street 1:21151 S WESTERN AVE
Practice Address - Street 2:SUITE 246
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1724
Practice Address - Country:US
Practice Address - Phone:866-522-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-17
Last Update Date:2013-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11314013103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst