Healthcare Provider Details

I. General information

NPI: 1215104898
Provider Name (Legal Business Name): ROMULO ESTEBAN MONTILLA PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 EWING HALSELL DR
SAN ANTONIO TX
78229-3715
US

IV. Provider business mailing address

8310 EWING HALSELL DR
SAN ANTONIO TX
78229-3715
US

V. Phone/Fax

Practice location:
  • Phone: 210-616-0885
  • Fax: 210-614-5633
Mailing address:
  • Phone: 210-616-0885
  • Fax: 210-614-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61195
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: