Basic Information
| Provider Information | |||||||||
| NPI: | 1952965451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTANEZ | ||||||||
| FirstName: | DARLENE | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4095 COUNTY CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513584606 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2813 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928825942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517372962 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2019 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172A00000X | CA | N | Other Service Providers | Driver | 101YA0400X | R1425290421 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.