Healthcare Provider Details

I. General information

NPI: 1518884105
Provider Name (Legal Business Name): LAURENT MONTEJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURENT MONTEJO GARCIA

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8309 91ST TER
SEMINOLE FL
33777-3208
US

IV. Provider business mailing address

8309 91ST TER
SEMINOLE FL
33777-3208
US

V. Phone/Fax

Practice location:
  • Phone: 786-716-0124
  • Fax:
Mailing address:
  • Phone: 786-716-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: