Healthcare Provider Details

I. General information

NPI: 1578961777
Provider Name (Legal Business Name): ROCIO MONTELONGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROCIO VARGAS

II. Dates (important events)

Enumeration Date: 12/21/2014
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BARRANCA ST STE 130
WEST COVINA CA
91791-1637
US

IV. Provider business mailing address

100 N BARRANCA ST STE 130
WEST COVINA CA
91791-1637
US

V. Phone/Fax

Practice location:
  • Phone: 626-433-1311
  • Fax:
Mailing address:
  • Phone: 626-433-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC6416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: