Healthcare Provider Details

I. General information

NPI: 1356791305
Provider Name (Legal Business Name): OSIEL MONTESERIN APRN FNP MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 NW 27TH AVE STE 130
MIAMI FL
33125-2173
US

IV. Provider business mailing address

1621 SW 107TH AVE
MIAMI FL
33165-7344
US

V. Phone/Fax

Practice location:
  • Phone: 305-635-7710
  • Fax: 786-621-7817
Mailing address:
  • Phone: 786-422-6525
  • Fax: 786-621-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9363400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: