Healthcare Provider Details

I. General information

NPI: 1396271946
Provider Name (Legal Business Name): GABRIEL MONTERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 FOREST HILL BLVD
WELLINGTON FL
33414
US

IV. Provider business mailing address

909 QUAYE LAKE CIR APT 102
WELLINGTON FL
33411-5048
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-8638
  • Fax:
Mailing address:
  • Phone: 787-932-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9379623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: