Provider Demographics
NPI:1548976392
Name:MONTELONGO, KATHERINE DANIELLE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DANIELLE
Last Name:MONTELONGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:DANIELLE
Other - Last Name:LOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KATIE
Mailing Address - Street 1:1600 DICKINSON AVE TRLR 409
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4699
Mailing Address - Country:US
Mailing Address - Phone:956-659-5277
Mailing Address - Fax:
Practice Address - Street 1:1600 DICKINSON AVE TRLR 409
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-4699
Practice Address - Country:US
Practice Address - Phone:956-659-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant