Healthcare Provider Details

I. General information

NPI: 1639035504
Provider Name (Legal Business Name): YASSER ABAD MONTOYA SR. RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 W 41ST ST APT 6
HIALEAH FL
33012-5818
US

IV. Provider business mailing address

1565 W 41ST ST APT 6
HIALEAH FL
33012-5818
US

V. Phone/Fax

Practice location:
  • Phone: 407-364-0203
  • Fax:
Mailing address:
  • Phone: 407-364-0203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number20230820128116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: