Provider Demographics
NPI:1437867140
Name:MONTES, MARTIN GONSALEZ (R1488051122)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:GONSALEZ
Last Name:MONTES
Suffix:
Gender:M
Credentials:R1488051122
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W MISSION AVE UNIT 404
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1605
Mailing Address - Country:US
Mailing Address - Phone:442-237-8656
Mailing Address - Fax:
Practice Address - Street 1:200 E WASHINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1806
Practice Address - Country:US
Practice Address - Phone:760-741-7708
Practice Address - Fax:760-741-5421
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)