Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | RW5007 | CA |
NPI | 1003226390 |
---|---|
Provider Name | Robert Montes |
First Address | La Habra, CA 90631-5525 |
Second Address | La Habra, CA 90631-5525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2014 |
Last Update Date | 28/05/2014 |