Provider Demographics
NPI:1528317625
Name:MONTECINO, CHRISTINE SUSAN (BA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:SUSAN
Last Name:MONTECINO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3977 OHIO STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104
Mailing Address - Country:US
Mailing Address - Phone:218-851-6735
Mailing Address - Fax:
Practice Address - Street 1:414 W. VERMONT AVE.
Practice Address - Street 2:STE 104
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-432-9884
Practice Address - Fax:760-432-9953
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator