MEDICARE: GINA MARIE MONTALBANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	102694	TX

General Provider Information

NPI Number	:	1477281483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MARIE MONTALBANO

Provider Business Mailing Address
First Line	:	8860 SNOWY OWL LOOP
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6849
Country	:	US
Telephone Number	:	832-483-8531
Fax Number	:

Provider Business Practice Location Address
First Line	:	8860 SNOWY OWL LOOP
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6849
Country	:	US
Telephone Number	:	832-483-8531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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Directions to “ GINA MARIE MONTALBANO ” Practice Location

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