Healthcare Provider Details

I. General information

NPI: 1093068678
Provider Name (Legal Business Name): ANDREA MONTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA PLATERO

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 W MAIN ST STE M
BRAWLEY CA
92227-2254
US

IV. Provider business mailing address

2344 HYACINTH RD
ALPINE CA
91901-1310
US

V. Phone/Fax

Practice location:
  • Phone: 619-323-5284
  • Fax:
Mailing address:
  • Phone: 619-323-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC13798
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC7355
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLPCC13798
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: