Healthcare Provider Details

I. General information

NPI: 1003226390
Provider Name (Legal Business Name): ROBERT MONTES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E LA HABRA BLVD
LA HABRA CA
90631-5525
US

IV. Provider business mailing address

402 E LA HABRA BLVD
LA HABRA CA
90631-5525
US

V. Phone/Fax

Practice location:
  • Phone: 562-644-0696
  • Fax:
Mailing address:
  • Phone: 562-644-0696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberRW5007
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRW5007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: