Healthcare Provider Details

I. General information

NPI: 1790061299
Provider Name (Legal Business Name): LUCIANA DIAS MONTEIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16264 CHURCH ST SUITE 103
MORGAN HILL CA
95037-7130
US

IV. Provider business mailing address

1600 W CAMPBELL AVE 102
CAMPBELL CA
95008-1526
US

V. Phone/Fax

Practice location:
  • Phone: 408-779-2113
  • Fax:
Mailing address:
  • Phone: 408-871-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF75265
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 94701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: