Provider Demographics
NPI:1164622452
Name:MONTELLA, RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:
Last Name:MONTELLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 E RANCHERO DR APT 6
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7952
Mailing Address - Country:US
Mailing Address - Phone:808-283-0495
Mailing Address - Fax:
Practice Address - Street 1:69730 HIGHWAY 111
Practice Address - Street 2:SUITE 109
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2869
Practice Address - Country:US
Practice Address - Phone:760-835-2419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPS2010035OtherREGISTERED PSYCHOLOGIST