Provider Demographics
NPI:1902502107
Name:MONTOYA, YISEDTH ANYULY
Entity type:Individual
Prefix:MRS
First Name:YISEDTH
Middle Name:ANYULY
Last Name:MONTOYA
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 1:1620 CUMMINS DRIVE MODESTO CA 95358
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358
Mailing Address - Country:US
Mailing Address - Phone:209-576-1750
Mailing Address - Fax:
Practice Address - Street 1:1620 CUMMINS DRIVE MODESTO CA 95358
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358
Practice Address - Country:US
Practice Address - Phone:209-576-1750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator