Provider Demographics
NPI:1609670298
Name:MONTANO, XAVIER L
Entity type:Individual
Prefix:
First Name:XAVIER
Middle Name:L
Last Name:MONTANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9626 BELLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MORONGO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92256-9541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77711 FLORA RD STE 327
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-4103
Practice Address - Country:US
Practice Address - Phone:626-313-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician