Provider Demographics
NPI:1629276357
Name:MONTEJO, CECILIA IVETTE (BA)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:IVETTE
Last Name:MONTEJO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:IVETTE
Other - Last Name:DE LEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18302 IRVINE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3437
Mailing Address - Country:US
Mailing Address - Phone:714-957-1004
Mailing Address - Fax:
Practice Address - Street 1:18302 IRVINE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3437
Practice Address - Country:US
Practice Address - Phone:714-957-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor