Healthcare Provider Details

I. General information

NPI: 1508771163
Provider Name (Legal Business Name): NATALIA CRISTINA MONTERO VAZQUEZ PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 FRANCE AVE S STE 230
EDINA MN
55435-1810
US

IV. Provider business mailing address

PO BOX 445
BOQUERON PR
00622-0445
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-2002
  • Fax: 651-383-4935
Mailing address:
  • Phone: 939-845-1468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP7375
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: