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NPI Code Detail

MEDICARE: IDALIS MONTERO

MEDICARE: IDALIS MONTERO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerSW21687FL

General Provider Information

NPI Number : 1003317199
Entity Type Code : Individual
Provider Name (Legal Business Name) : IDALIS MONTERO
Provider Business Mailing Address
First Line : 5460 SILTSTONE ST
Second Line :
City : LAKELAND
State : FL
Zip : 33811-3170
Country : US
Telephone Number : 203-873-9212
Fax Number :
Provider Business Practice Location Address
First Line : 1010 E ROSE ST
Second Line :
City : LAKELAND
State : FL
Zip : 33801-2016
Country : US
Telephone Number : 863-413-3126
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2018
Last Update Date : 01/28/2026

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Directions to “ IDALIS MONTERO ” Practice Location

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