Healthcare Provider Details

I. General information

NPI: 1376670208
Provider Name (Legal Business Name): NINOSKA MONTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/22/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12495 LIMONITE AVE # 1128
EASTVALE CA
91752-2457
US

IV. Provider business mailing address

12495 LIMONITE AVE # 1128
EASTVALE CA
91752-2457
US

V. Phone/Fax

Practice location:
  • Phone: 626-590-1820
  • Fax:
Mailing address:
  • Phone: 626-590-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number47419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: