MEDICARE: JUAN CARLOS MONTAS DIAZ PA

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	363AM0700X	Medical Physician Assistant	120	FL
2	363AM0700X	Medical Physician Assistant	922	PR

General Provider Information

NPI Number	:	1265027338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS MONTAS DIAZ PA

Provider Business Mailing Address
First Line	:	12024 MAGAZINE ST APT 9205
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-5511
Country	:	US
Telephone Number	:	407-860-7388
Fax Number	:

Provider Business Practice Location Address
First Line	:	12024 MAGAZINE ST APT 9205
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-5511
Country	:	US
Telephone Number	:	407-860-7388
Fax Number	:

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

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/01/2021

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Directions to “ JUAN CARLOS MONTAS DIAZ PA” Practice Location

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