Provider Demographics
NPI:1811245053
Name:MONTES DE OCA, ABIGAIL
Entity type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:
Last Name:MONTES DE OCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 DEL REY DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-1827
Mailing Address - Country:US
Mailing Address - Phone:909-269-0217
Mailing Address - Fax:
Practice Address - Street 1:317 W F ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3205
Practice Address - Country:US
Practice Address - Phone:909-986-7111
Practice Address - Fax:909-986-0941
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health