Individual
JOHANNA CAROLINA MONTOYA CASTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2355 S WESTERN AVE, CHICAGO, IL 60608-3837
(773) 254-1400
Mailing address
966 W 21ST ST, CHICAGO, IL 60608-4511
(773) 254-1400
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085006409
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IL
Enumeration date
11/02/2017
Last updated
03/17/2018
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