Provider Demographics
NPI:1992914543
Name:MONTANERO, KAMMI
Entity type:Individual
Prefix:
First Name:KAMMI
Middle Name:
Last Name:MONTANERO
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 1:8661 WINTER GARDENS BLVD
Mailing Address - Street 2:SP # 93
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-5400
Mailing Address - Country:US
Mailing Address - Phone:619-390-1093
Mailing Address - Fax:
Practice Address - Street 1:8661 WINTER GARDENS BLVD
Practice Address - Street 2:SP # 93
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-5400
Practice Address - Country:US
Practice Address - Phone:619-390-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)