Provider Demographics
NPI:1164622452
Name:MONTELLA, RAY (PHD)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:
Last Name:MONTELLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 VIA FELIZ # 230
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-4324
Mailing Address - Country:US
Mailing Address - Phone:808-283-0495
Mailing Address - Fax:
Practice Address - Street 1:69730 HIGHWAY 111
Practice Address - Street 2:SUITE 109
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2869
Practice Address - Country:US
Practice Address - Phone:760-835-2419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27062103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPS2010035OtherREGISTERED PSYCHOLOGIST