Individual provider · Type 1 NPI

Kennisha Montgomery

Student in an Organized Health Care Education/Training Program · Azusa, CA

NPI number 1205320504 Active

Practice location

901 E Alosta Ave
Azusa, CA 91702-2701

Call (626) 815-6000 Map

Mailing address

4407 Oakhollow Dr Apt 74
Sacramento, CA 95842-4012

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed
Athletic Trainer 2255A2300XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1205320504

Kennisha Montgomery's National Provider Identifier is 1205320504, issued on Jun 20, 2018. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Azusa, CA. The record was last updated on Jun 20, 2018.