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General NPI Number Information
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NPI Number | 1740455849
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Entity Type | Individual
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Provider Name | CARLOS MONTES DE OCA PAEZ B.S.- R.A.S.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 163 SHEPARD LN C
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City | BISHOP
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State | CA
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Zip | 93514-2133
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Country | US
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Telephone | 760-258-7132
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Fax |
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Provider Business Mailing Address
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Address Line | 163C SHEPARD LN
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City | BISHOP
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State | CA
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Zip | 93514-2133
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Country | US
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Telephone | 760-258-7132
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MO403021116
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MO403021116
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MO403021116
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License Number State | CA
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