Provider Demographics
NPI:1720422991
Name:MONTECILLO, THERESA (APN)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:MONTECILLO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 Q ST STE 201-202
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1662
Mailing Address - Country:US
Mailing Address - Phone:661-432-1451
Mailing Address - Fax:661-489-5040
Practice Address - Street 1:3550 Q ST STE 201-202
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1662
Practice Address - Country:US
Practice Address - Phone:661-432-1451
Practice Address - Fax:661-489-5040
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001498363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner