MEDICARE: ANA V PLAZA MONTERO P.H.D.

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	103TC0700X	Clinical Psychologist	3443	PR

General Provider Information

NPI Number	:	1063742179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA V PLAZA MONTERO P.H.D.

Provider Business Mailing Address
First Line	:	11175 CALLE MIOSOTI
Second Line	:	URB CONCORDIA
City	:	SANTA ISABEL
State	:	PR
Zip	:	00757-3120
Country	:	US
Telephone Number	:	939-579-9399
Fax Number	:	787-844-3077

Provider Business Practice Location Address
First Line	:	2604 AVE LAS AMERICAS
Second Line	:	URB CONSTANCIA
City	:	PONCE
State	:	PR
Zip	:	00717-2107
Country	:	US
Telephone Number	:	787-844-3077
Fax Number	:	787-844-3077

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

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	02/15/2011

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