Individual
ITZIA ADILENE BASULTO MONTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
58457 TWENTYNINE PALMS HIGHWAY, SUITE 102A, YUCCA VALLEY, CA 92284
(760) 228-9657
(442) 205-0060
Mailing address
58457 TWENTYNINE PALMS HIGHWAY, SUITE 102A, YUCCA VALLEY, CA 92284
(760) 228-9657
(442) 205-0060
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-VMFYNA
CA
373H00000X
Day Training/Habilitation Specialist
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—
Other
Enumeration date
10/21/2025
Last updated
06/18/2026
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