Provider Demographics
NPI:1164080255
Name:MONTENEGRO, MARIA CELIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CELIA
Last Name:MONTENEGRO
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 1:2351 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3558
Mailing Address - Country:US
Mailing Address - Phone:510-478-4794
Mailing Address - Fax:
Practice Address - Street 1:3109 ANDRADE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1109
Practice Address - Country:US
Practice Address - Phone:510-426-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty