Provider Demographics
NPI:1043990815
Name:MONTANEZ, ANA CITLALY
Entity Type:Individual
Prefix:MISS
First Name:ANA
Middle Name:CITLALY
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 1:5413 S ROCKWELL ST # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-1516
Mailing Address - Country:US
Mailing Address - Phone:708-435-3022
Mailing Address - Fax:
Practice Address - Street 1:7222 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1422
Practice Address - Country:US
Practice Address - Phone:866-695-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician