MEDICARE: NATHALIA MARIA MONTES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1023636339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALIA MARIA MONTES

Provider Business Mailing Address
First Line	:	1100 EVERTON PL
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-4475
Country	:	US
Telephone Number	:	760-296-8157
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 EVERTON PL
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-4475
Country	:	US
Telephone Number	:	760-296-8157
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	07/13/2020

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Directions to “ NATHALIA MARIA MONTES ” Practice Location

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