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General NPI Number Information
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NPI Number | 1780018390
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Entity Type | Individual
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Provider Name | MICHAEL ANGELO MONTANTES
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Gender | Male
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Dates
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Enumeration Date | 08/30/2013
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 1212 N CALIFORNIA ST
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City | STOCKTON
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State | CA
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Zip | 95202-1552
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Country | US
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Telephone | 209-468-8667
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Fax |
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Provider Business Mailing Address
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Address Line | 8709 GLENBRIAR DR
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City | STOCKTON
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State | CA
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Zip | 95209-2008
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Country | US
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Telephone | 209-762-7644
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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 | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | 37071
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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