Provider Demographics
NPI:1427662402
Name:MONTANO, ISIS ELOISA (MC19256)
Entity type:Individual
Prefix:
First Name:ISIS
Middle Name:ELOISA
Last Name:MONTANO
Suffix:
Gender:F
Credentials:MC19256
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 S 136TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2862
Mailing Address - Country:US
Mailing Address - Phone:206-519-0679
Mailing Address - Fax:206-208-6167
Practice Address - Street 1:1212 S 136TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98168-2862
Practice Address - Country:US
Practice Address - Phone:206-519-0679
Practice Address - Fax:206-208-6167
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC19256171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter