Provider Demographics
NPI:1487855516
Name:MONTES, JESUS
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:MONTES
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 1:901 S COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-5910
Mailing Address - Country:US
Mailing Address - Phone:559-361-1688
Mailing Address - Fax:
Practice Address - Street 1:310 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5009
Practice Address - Country:US
Practice Address - Phone:559-734-6042
Practice Address - Fax:559-635-4788
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA545416Medicaid