Healthcare Provider Details

I. General information

NPI: 1598683393
Provider Name (Legal Business Name): LUIS MONTANO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 NW 82ND AVE STE 400
DORAL FL
33166-7602
US

IV. Provider business mailing address

3625 NW 82ND AVE STE 400
DORAL FL
33166-7602
US

V. Phone/Fax

Practice location:
  • Phone: 786-731-4760
  • Fax:
Mailing address:
  • Phone: 786-731-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: