Healthcare Provider Details

I. General information

NPI: 1033401831
Provider Name (Legal Business Name): GABRIEL CARLOS MONTHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 W SHAW LN STE 104
FRESNO CA
93711-2777
US

IV. Provider business mailing address

7905 VICTORIA DR NW
ALBUQUERQUE NM
87120-3189
US

V. Phone/Fax

Practice location:
  • Phone: 559-443-4800
  • Fax:
Mailing address:
  • Phone: 505-573-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA162528
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA162528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: