MEDICARE: JUDITH ROSALYN MONTALVAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician		FL

General Provider Information

NPI Number	:	1063048585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH ROSALYN MONTALVAN

Provider Business Mailing Address
First Line	:	1101 NE 214TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-1317
Country	:	US
Telephone Number	:	305-610-5229
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 NE 60TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-2127
Country	:	US
Telephone Number	:	954-830-9508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2020
Last Update Date	:	03/16/2020

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