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General NPI Number Information
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NPI Number | 1295084127
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Entity Type | Organization
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Legal Business Name | DESALY MONTILLA M.D.L.L.C.
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 8525 SW 92ND ST SUITE B-4
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City | MIAMI
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State | FL
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Zip | 33156-7365
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Country | US
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Telephone | 305-279-7446
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Fax | 305-598-8753
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Provider Business Mailing Address
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Address Line | 8525 SW 92ND ST SUITE B-4
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City | MIAMI
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State | FL
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Zip | 33156-7365
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Country | US
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Telephone | 305-279-7446
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Fax | 305-598-8753
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DESALY M GONZALEZ
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Credential |
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Telephone | 305-279-7446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME39089
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License Number State | FL
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