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Individual

OMAYRA MONTALVO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
900 MAIN ST, BRAWLEY, CA 92227-2630
(760) 344-6471
(760) 344-8410
Mailing address
1136 CALLE DEL SOL, BRAWLEY, CA 92227-7747
(760) 344-9951

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
23182
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1649269747
CA
Enumeration date
10/01/2013
Last updated
10/01/2013
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