Provider Demographics
NPI:1275284879
Name:MONTIEL, AMBER RENEE
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:RENEE
Last Name:MONTIEL
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 1:1104 E NAVAJO ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-4046
Mailing Address - Country:US
Mailing Address - Phone:760-373-0997
Mailing Address - Fax:
Practice Address - Street 1:1104 E NAVAJO ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-4046
Practice Address - Country:US
Practice Address - Phone:760-373-0997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF3319822106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician