Healthcare Provider Details

I. General information

NPI: 1811566110
Provider Name (Legal Business Name): DANIEL EMILIO MONTANEZ PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 07/25/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM. 55 BO. PALENQUE
BARCELONETA PR
00617-0061
US

IV. Provider business mailing address

PO BOX 1491
MANATI PR
00674-1491
US

V. Phone/Fax

Practice location:
  • Phone: 787-904-8612
  • Fax:
Mailing address:
  • Phone: 787-904-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7026
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: