Provider Demographics
NPI:1386830743
Name:MONTANEZ, BELINDA JACOBS (BA, ITFS)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:JACOBS
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:BA, ITFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SCOTTY DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-3365
Mailing Address - Country:US
Mailing Address - Phone:919-738-7193
Mailing Address - Fax:919-221-6025
Practice Address - Street 1:1510 SCOTTY DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-3365
Practice Address - Country:US
Practice Address - Phone:919-738-7193
Practice Address - Fax:919-221-6025
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300034Medicaid