Provider Demographics
NPI:1235261934
Name:MONTERO, EUGIELYN
Entity Type:Individual
Prefix:
First Name:EUGIELYN
Middle Name:
Last Name:MONTERO
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 1:1727 SWEETWATER RD STE 117
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7651
Mailing Address - Country:US
Mailing Address - Phone:619-434-2063
Mailing Address - Fax:619-336-0201
Practice Address - Street 1:1727 SWEETWATER RD STE 117
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7651
Practice Address - Country:US
Practice Address - Phone:619-434-2063
Practice Address - Fax:619-336-0201
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10381-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40467400Medicaid