Healthcare Provider Details

I. General information

NPI: 1235015157
Provider Name (Legal Business Name): STEPHANIE ALICIA MONTERO ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 SAN JACINTO RIVER RD STE 1
LAKE ELSINORE CA
92530-4419
US

IV. Provider business mailing address

265 SAN JACINTO RIVER RD STE 1
LAKE ELSINORE CA
92530-4419
US

V. Phone/Fax

Practice location:
  • Phone: 951-674-9243
  • Fax:
Mailing address:
  • Phone: 951-674-9243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW139562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: