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NPI Code Detail

MEDICARE: JUAN CARLOS MONTELONGO JR.

MEDICARE: JUAN CARLOS MONTELONGO JR.
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1548905631
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN CARLOS MONTELONGO JR.
Provider Business Mailing Address
First Line : 192 PLYMOUTH DR
Second Line :
City : CLAYTON
State : NC
Zip : 27520-2894
Country : US
Telephone Number : 956-246-5718
Fax Number :
Provider Business Practice Location Address
First Line : 201 MACKENAN DR
Second Line :
City : CARY
State : NC
Zip : 27511-6498
Country : US
Telephone Number : 919-502-4109
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2022
Last Update Date : 05/03/2022

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Directions to “ JUAN CARLOS MONTELONGO JR. ” Practice Location

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