Healthcare Provider Details

I. General information

NPI: 1619536745
Provider Name (Legal Business Name): DIEGO MICHAEL MONTOYA-CERRILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE FL 33136
MIAMI FL
33136-1005
US

IV. Provider business mailing address

185 SE 14TH TER APT 2508
MIAMI FL
33131-3422
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1111
  • Fax:
Mailing address:
  • Phone: 786-395-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME163036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: