Provider Demographics
NPI:1851922132
Name:MONTIEL, ROGELIO (LVN)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:MONTIEL
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1231
Mailing Address - Country:US
Mailing Address - Phone:805-302-8577
Mailing Address - Fax:
Practice Address - Street 1:1009 LAUREL RD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-1231
Practice Address - Country:US
Practice Address - Phone:805-302-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA684466164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse