Provider Demographics
NPI:1871799098
Name:MONTGOMERY, YVITA C (BS)
Entity type:Individual
Prefix:MISS
First Name:YVITA
Middle Name:C
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MISS
Other - First Name:YVITA
Other - Middle Name:C
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:757 W SEPULVEDA ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-1941
Mailing Address - Country:US
Mailing Address - Phone:213-639-2689
Mailing Address - Fax:213-389-1987
Practice Address - Street 1:2500 WILSHIRE BLVD
Practice Address - Street 2:7
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4303
Practice Address - Country:US
Practice Address - Phone:213-639-2689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner