Provider Demographics
NPI:1861054264
Name:MONTEL, SEBASTIEN ROBERT EDOUARD (PHD)
Entity type:Individual
Prefix:DR
First Name:SEBASTIEN
Middle Name:ROBERT EDOUARD
Last Name:MONTEL
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:PO BOX 80156
Mailing Address - Street 2:
Mailing Address - City:RANCHO STA MARG
Mailing Address - State:CA
Mailing Address - Zip Code:92688-0156
Mailing Address - Country:US
Mailing Address - Phone:949-220-6642
Mailing Address - Fax:
Practice Address - Street 1:27201 PUERTA REAL STE 300
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8590
Practice Address - Country:US
Practice Address - Phone:949-220-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical