Provider Demographics
NPI:1972328631
Name:HARTMAN MONTEJO, DANIELA MARIA
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:MARIA
Last Name:HARTMAN MONTEJO
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 1:1312 E POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8003
Mailing Address - Country:US
Mailing Address - Phone:971-312-7485
Mailing Address - Fax:
Practice Address - Street 1:1312 E POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8003
Practice Address - Country:US
Practice Address - Phone:971-312-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR930841022175T00000X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
No175T00000XOther Service ProvidersPeer Specialist