Healthcare Provider Details

I. General information

NPI: 1700709557
Provider Name (Legal Business Name): MICHAEL THOMAS MONTANIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 GATEWAY DR STE 225
RIVERSIDE CA
92507-0908
US

IV. Provider business mailing address

6432 E VIA ARBOLES
ANAHEIM CA
92807-4219
US

V. Phone/Fax

Practice location:
  • Phone: 858-264-5858
  • Fax:
Mailing address:
  • Phone: 714-348-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: