Organization
CYH MEDICAL GROUP (DE), P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL JOHN MONTVILLE (CHIEF MEDICAL OFFICER)
(612) 805-7008
Entity
Organization
Contact information
Practice address
4136 DEL REY AVE, MARINA DEL REY, CA 90292-5604
(410) 886-7398
Mailing address
4136 DEL REY AVE, MARINA DEL REY, CA 90292-5604
(410) 886-7398
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
07/22/2022
Last updated
07/24/2025
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