Provider Demographics
NPI:1740455849
Name:MONTES DE OCA PAEZ, CARLOS (BS- RAS)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:MONTES DE OCA PAEZ
Suffix:
Gender:M
Credentials:BS- RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163C SHEPARD LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2133
Mailing Address - Country:US
Mailing Address - Phone:760-258-7132
Mailing Address - Fax:
Practice Address - Street 1:163 SHEPARD LN
Practice Address - Street 2:C
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2133
Practice Address - Country:US
Practice Address - Phone:760-258-7132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMO403021116101Y00000X, 101YA0400X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness