MEDICARE: OSVALDO ORGELIO MARTIN MONTEJO

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1548771462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSVALDO ORGELIO MARTIN MONTEJO

Provider Business Mailing Address
First Line	:	3933 SW KAMSLER ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-4046
Country	:	US
Telephone Number	:	772-626-5108
Fax Number	:

Provider Business Practice Location Address
First Line	:	3933 SW KAMSLER ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-4046
Country	:	US
Telephone Number	:	772-626-5108
Fax Number	:

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

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	04/11/2023

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Directions to “ OSVALDO ORGELIO MARTIN MONTEJO ” Practice Location

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