Provider Demographics
NPI:1538478904
Name:MONTERO, ABRAHAM RAFAEL (BA IN PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:RAFAEL
Last Name:MONTERO
Suffix:
Gender:M
Credentials:BA IN PSYCHOLOGY
Other - Prefix:
Other - First Name:ABRAHAM
Other - Middle Name:RAFAEL
Other - Last Name:MONTERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA IN PSYCHOLOGY
Mailing Address - Street 1:6865 GOLD NUGGET DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-8606
Mailing Address - Country:US
Mailing Address - Phone:562-445-7708
Mailing Address - Fax:
Practice Address - Street 1:6865 GOLD NUGGET DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-8606
Practice Address - Country:US
Practice Address - Phone:562-445-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health