=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184270100
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONSUELO MONTOYA SLPA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2019
-----------------------------------------------------
Last Update Date | 08/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9290 HAMMOCKS BLVD STE 401
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33196-1347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-558-5694
-----------------------------------------------------
Fax | 786-913-7034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14924 SW 88TH TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33196-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-498-0409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | SI1314
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------