Basic Information
| Provider Information | |||||||||
| NPI: | 1760540959 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YAMAT | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | MONTANO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MONTANO | ||||||||
| OtherFirstName: | SANDRA | ||||||||
| OtherMiddleName: | T | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7424 BRIDGEPORT WAY WEST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984998137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535812111 | ||||||||
| FaxNumber: | 2535812712 | ||||||||
| Practice Location | |||||||||
| Address1: | 7424 BRIDGEPORT WAY WEST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984998137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535812111 | ||||||||
| FaxNumber: | 2535812712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 09/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD60025230 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 8521940 | 05 | WA | MEDICAID |