Healthcare Provider Details

I. General information

NPI: 1609066265
Provider Name (Legal Business Name): MONTILLA & MARTINEZ, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 TAUREN CT
NAPLES FL
34119-7717
US

IV. Provider business mailing address

8005 TAUREN CT
NAPLES FL
34119-7717
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-5211
  • Fax: 239-236-1310
Mailing address:
  • Phone: 239-304-5211
  • Fax: 239-236-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. JAIME MONTILLA
Title or Position: PRESIDENT
Credential:
Phone: 239-304-5211