Healthcare Provider Details

I. General information

NPI: 1528317625
Provider Name (Legal Business Name): CHRISTINE SUSAN MONTECINO B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W. VERMONT AVE. STE 104
ESCONDIDO CA
92025
US

IV. Provider business mailing address

3977 OHIO STREET
SAN DIEGO CA
92104
US

V. Phone/Fax

Practice location:
  • Phone: 760-432-9884
  • Fax: 760-432-9953
Mailing address:
  • Phone: 218-851-6735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: