Provider Demographics
NPI:1043414659
Name:MONTANEZ, GLORIA
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 FENTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3517
Mailing Address - Country:US
Mailing Address - Phone:619-428-9300
Mailing Address - Fax:
Practice Address - Street 1:2429 FENTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3517
Practice Address - Country:US
Practice Address - Phone:619-428-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)