Healthcare Provider Details

I. General information

NPI: 1952965451
Provider Name (Legal Business Name): DARLENE M MONTANEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 S MAIN ST
CORONA CA
92882-5942
US

IV. Provider business mailing address

4095 COUNTY CIRCLE DR
RIVERSIDE CA
92503-3410
US

V. Phone/Fax

Practice location:
  • Phone: 951-737-2962
  • Fax:
Mailing address:
  • Phone: 951-358-4606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1425290421
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: