Provider Demographics
NPI:1194591800
Name:MONTOYA, RACHELLE CRISOSTOMO
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:CRISOSTOMO
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:DIMAPILIS
Other - Last Name:CRISOSTOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15330 ELMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4707
Mailing Address - Country:US
Mailing Address - Phone:562-544-7088
Mailing Address - Fax:
Practice Address - Street 1:1731 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1837
Practice Address - Country:US
Practice Address - Phone:714-677-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist