MEDICARE: ROBERTO MONTEZ

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	224Z00000X	Occupational Therapy Assistant	210878	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	210878	OTHER	TX	TEXAS LICENSE

General Provider Information

NPI Number	:	1942728456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO MONTEZ

Provider Business Mailing Address
First Line	:	1205 N RAUL LONGORIA RD STE I
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589-3721
Country	:	US
Telephone Number	:	956-782-5800
Fax Number	:	956-782-5802

Provider Business Practice Location Address
First Line	:	1205 N RAUL LONGORIA RD STE I
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589-3721
Country	:	US
Telephone Number	:	956-782-5800
Fax Number	:	956-782-5802

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

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	07/21/2022

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Directions to “ ROBERTO MONTEZ ” Practice Location

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