MEDICARE: MR. EDUARDO A MONTES

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1366887879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDUARDO A MONTES

Provider Business Mailing Address
First Line	:	6721 SW 12TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33023-2047
Country	:	US
Telephone Number	:	954-668-9852
Fax Number	:

Provider Business Practice Location Address
First Line	:	6721 SW 12 ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33023
Country	:	US
Telephone Number	:	954-668-9852
Fax Number	:

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

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	05/10/2013

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