Provider Demographics
NPI:1053194324
Name:MONTANEZ, RAFAEL (BA)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:VALENTINA
Other - Middle Name:
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:1216 ARCH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2835
Mailing Address - Country:US
Mailing Address - Phone:267-940-5504
Mailing Address - Fax:215-558-6637
Practice Address - Street 1:1216 ARCH ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2835
Practice Address - Country:US
Practice Address - Phone:267-940-5504
Practice Address - Fax:215-558-6637
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator