Healthcare Provider Details

I. General information

NPI: 1508215146
Provider Name (Legal Business Name): ADRIANA L MONCAYO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2016
Last Update Date: 07/30/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W ALEXANDER ST
PLANT CITY FL
33563-7116
US

IV. Provider business mailing address

1324 LAKELAND HILLS BLVD
LAKELAND FL
33805-4543
US

V. Phone/Fax

Practice location:
  • Phone: 863-284-5115
  • Fax: 863-284-1916
Mailing address:
  • Phone: 863-687-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME148338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: