Provider Demographics
NPI:1619055720
Name:MONTANO, CARLOS XAVIER JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:XAVIER
Last Name:MONTANO
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 RED HILL AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3436
Mailing Address - Country:US
Mailing Address - Phone:949-478-1487
Mailing Address - Fax:
Practice Address - Street 1:1400 QUAIL ST STE 136
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2788
Practice Address - Country:US
Practice Address - Phone:949-478-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical