Provider Demographics
NPI:1922870898
Name:MONTESINO, FELIX
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:MONTESINO
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 1:114 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-4548
Mailing Address - Country:US
Mailing Address - Phone:574-215-3631
Mailing Address - Fax:
Practice Address - Street 1:114 MULBERRY LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-4548
Practice Address - Country:US
Practice Address - Phone:574-215-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000045856552405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional