MEDICARE: DR. ELOISA CAROLINA MONTOYA PSY.D.

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
1	103TC0700X	Clinical Psychologist	PY4015	FL

General Provider Information

NPI Number	:	1235212093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELOISA CAROLINA MONTOYA PSY.D.

Provider Business Mailing Address
First Line	:	944 NW 106TH AVENUE CIR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33172-3123
Country	:	US
Telephone Number	:	305-221-4288
Fax Number	:

Provider Business Practice Location Address
First Line	:	11401 SW 40TH ST
Second Line	:	SUITE 305
City	:	MIAMI
State	:	FL
Zip	:	33165-3372
Country	:	US
Telephone Number	:	305-221-4288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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