Provider Demographics
NPI:1376074450
Name:MONTIEL, NATHANIEL
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:
Last Name:MONTIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 TEAL LN
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3167
Mailing Address - Country:US
Mailing Address - Phone:510-938-8850
Mailing Address - Fax:
Practice Address - Street 1:2605 TEAL LN
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3167
Practice Address - Country:US
Practice Address - Phone:510-938-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP32540146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic