Provider Demographics
NPI:1669358610
Name:MONTIEL, HALEY LISSETHE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:LISSETHE
Last Name:MONTIEL
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 1:401 S AIRPORT WAY
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8426
Mailing Address - Country:US
Mailing Address - Phone:209-825-1350
Mailing Address - Fax:
Practice Address - Street 1:401 S AIRPORT WAY
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-8426
Practice Address - Country:US
Practice Address - Phone:209-825-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA751851164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse