Healthcare Provider Details

I. General information

NPI: 1649141342
Provider Name (Legal Business Name): ELIZABETH MONTERO VALDES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 MILLENIA BLVD
ORLANDO FL
32839-6012
US

IV. Provider business mailing address

1400 S ORANGE AVE
ORLANDO FL
32806-2134
US

V. Phone/Fax

Practice location:
  • Phone: 407-264-5601
  • Fax:
Mailing address:
  • Phone: 877-876-3627
  • Fax: 321-841-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA9120964
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: