Provider Demographics
NPI:1477255826
Name:GOMEZ MONTERO, NTALIE
Entity Type:Individual
Prefix:
First Name:NTALIE
Middle Name:
Last Name:GOMEZ MONTERO
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 1:1105 N CURTIS CT APT D
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2739
Mailing Address - Country:US
Mailing Address - Phone:714-348-8430
Mailing Address - Fax:
Practice Address - Street 1:7108 SOUTH KANNER HWY, STUART
Practice Address - Street 2:
Practice Address - City:STUART FL
Practice Address - State:FL
Practice Address - Zip Code:34997
Practice Address - Country:US
Practice Address - Phone:185-583-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician