Provider Demographics
NPI:1487261905
Name:MONTES, KASANDRA
Entity type:Individual
Prefix:
First Name:KASANDRA
Middle Name:
Last Name:MONTES
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:PO BOX 2619
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-2619
Mailing Address - Country:US
Mailing Address - Phone:760-924-1740
Mailing Address - Fax:760-924-1741
Practice Address - Street 1:1290 TAVERN ROAD
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-9354
Practice Address - Country:US
Practice Address - Phone:760-924-1740
Practice Address - Fax:760-924-1741
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator