Provider Demographics
NPI:1346752979
Name:MONTIEL, KATHLEEN MARIE
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MONTIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:MONTIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KAT
Mailing Address - Street 1:1148 CARLSBAD ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-4734
Mailing Address - Country:US
Mailing Address - Phone:619-718-0029
Mailing Address - Fax:
Practice Address - Street 1:1148 CARLSBAD ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-4734
Practice Address - Country:US
Practice Address - Phone:619-718-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-05
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician