Healthcare Provider Details

I. General information

NPI: 1932945839
Provider Name (Legal Business Name): MARIELA MONTERO CHANG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 SW 288TH ST STE 310
HOMESTEAD FL
33033-1223
US

IV. Provider business mailing address

515 SE 30TH DR
HOMESTEAD FL
33033-5764
US

V. Phone/Fax

Practice location:
  • Phone: 786-404-3225
  • Fax: 786-404-3239
Mailing address:
  • Phone: 305-322-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11024646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: