Healthcare Provider Details

I. General information

NPI: 1477116606
Provider Name (Legal Business Name): DELANA MARIE MONTGOMERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 PRESLEY AVE
RIVERSIDE CA
92507-4453
US

IV. Provider business mailing address

3144 MARY ST
RIVERSIDE CA
92506-4234
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-8006
  • Fax:
Mailing address:
  • Phone: 951-410-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRH0011631023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: