Provider Demographics
NPI:1508676719
Name:MONTEZ, NATHAN JOSEPH (HS DIPLOMA)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:JOSEPH
Last Name:MONTEZ
Suffix:
Gender:M
Credentials:HS DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 S CARNEGIE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4201
Mailing Address - Country:US
Mailing Address - Phone:909-277-6090
Mailing Address - Fax:
Practice Address - Street 1:473 S CARNEGIE DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4207
Practice Address - Country:US
Practice Address - Phone:909-277-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician