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General NPI Number Information
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NPI Number | 1265034367
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Entity Type | Individual
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Provider Name | CORAL MONTECINOS-WILSON
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Gender | Female
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 3490 LA SIERRA AVE STE F920
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City | RIVERSIDE
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State | CA
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Zip | 92503-5214
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Country | US
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Telephone | 951-723-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 3490 LA SIERRA AVE STE F920
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City | RIVERSIDE
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State | CA
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Zip | 92503-5214
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Country | US
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Telephone | 951-723-5311
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 170198472
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License Number State | CA
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