Provider Demographics
NPI:1386344539
Name:CHATMON, MONTAY
Entity type:Individual
Prefix:
First Name:MONTAY
Middle Name:
Last Name:CHATMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18394 BLYTHE WAY
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-2262
Mailing Address - Country:US
Mailing Address - Phone:951-293-1874
Mailing Address - Fax:
Practice Address - Street 1:18394 BLYTHE WAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-2262
Practice Address - Country:US
Practice Address - Phone:951-293-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7119310172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA922680529OtherSCOOP TRANSPORTATIONS LLC
CA922680529OtherMONTAY CHATMAN