MEDICARE: LUCIANA DIAS MONTEIRO

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	106H00000X	Marriage & Family Therapist	IMF75265	CA
2	106H00000X	Marriage & Family Therapist	LMFT 94701	CA

General Provider Information

NPI Number	:	1790061299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIANA DIAS MONTEIRO

Provider Business Mailing Address
First Line	:	1600 W CAMPBELL AVE
Second Line	:	102
City	:	CAMPBELL
State	:	CA
Zip	:	95008-1526
Country	:	US
Telephone Number	:	408-871-4924
Fax Number	:

Provider Business Practice Location Address
First Line	:	16264 CHURCH ST
Second Line	:	SUITE 103
City	:	MORGAN HILL
State	:	CA
Zip	:	95037-7130
Country	:	US
Telephone Number	:	408-779-2113
Fax Number	:

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

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	08/17/2016

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Directions to “ LUCIANA DIAS MONTEIRO ” Practice Location

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