Healthcare Provider Details

I. General information

NPI: 1649467903
Provider Name (Legal Business Name): ANGEL MONTERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 SW 12TH AVE STE 302
MIAMI FL
33130-2433
US

IV. Provider business mailing address

200 SE 15TH RD APT 5D
MIAMI FL
33129-1161
US

V. Phone/Fax

Practice location:
  • Phone: 305-443-2090
  • Fax: 305-443-2002
Mailing address:
  • Phone: 786-339-1867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME102172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: