Healthcare Provider Details

I. General information

NPI: 1225322506
Provider Name (Legal Business Name): JIMMY MONTEALEGRE JR. RT, CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2011
Last Update Date: 06/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR
OCOEE FL
34761-3400
US

IV. Provider business mailing address

3126 ANQUILLA AVE
CLERMONT FL
34711-5297
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-1169
  • Fax:
Mailing address:
  • Phone: 407-616-8803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT769
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberCRT74381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: