Healthcare Provider Details

I. General information

NPI: 1659921146
Provider Name (Legal Business Name): ROBIN MARIE MONTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4049 MILLER WAY
SACRAMENTO CA
95817-1332
US

IV. Provider business mailing address

4049 MILLER WAY
SACRAMENTO CA
95817-1332
US

V. Phone/Fax

Practice location:
  • Phone: 916-451-9312
  • Fax: 916-451-4018
Mailing address:
  • Phone: 916-451-9312
  • Fax: 916-451-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: