Provider Demographics
NPI:1427838713
Name:MONTORO, HALEY (PA-C)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:MONTORO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 1/2 DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1405
Mailing Address - Country:US
Mailing Address - Phone:304-685-1708
Mailing Address - Fax:
Practice Address - Street 1:18433 ROSCOE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4127
Practice Address - Country:US
Practice Address - Phone:888-367-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63435207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty