Provider Demographics
NPI:1427294354
Name:MONTALVO, DARLENE PATRICIA
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:PATRICIA
Last Name:MONTALVO
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 1:1725 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3289
Mailing Address - Country:US
Mailing Address - Phone:310-260-3542
Mailing Address - Fax:310-395-7971
Practice Address - Street 1:1725 MAIN ST
Practice Address - Street 2:R
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-3289
Practice Address - Country:US
Practice Address - Phone:310-260-3542
Practice Address - Fax:310-395-7971
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator