Provider Demographics
NPI:1134251754
Name:MONTIEL, PABLO I (BA)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:I
Last Name:MONTIEL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 CAMINO DEL RIO S
Mailing Address - Street 2:215
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4026
Mailing Address - Country:US
Mailing Address - Phone:619-584-5777
Mailing Address - Fax:619-584-5760
Practice Address - Street 1:3517 CAMINO DEL RIO S
Practice Address - Street 2:215
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4026
Practice Address - Country:US
Practice Address - Phone:619-584-5777
Practice Address - Fax:619-584-5760
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6388OtherINSYST NUMBER