Healthcare Provider Details

I. General information

NPI: 1306028873
Provider Name (Legal Business Name): MRS. BRENDA LIZETTE MONTANEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. BRENDA LIZETTE MEZA

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9829 CARMENITA RD STE H
WHITTIER CA
90605-3262
US

IV. Provider business mailing address

171 E ADAIR ST
LONG BEACH CA
90805-3447
US

V. Phone/Fax

Practice location:
  • Phone: 562-907-7429
  • Fax:
Mailing address:
  • Phone: 562-852-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW30241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: