MEDICARE: YASSER ABAD MONTOYA SR. RPT

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	246RP1900X	Phlebotomy Technician	20230820128116	FL

General Provider Information

NPI Number	:	1639035504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASSER ABAD MONTOYA SR. RPT

Provider Business Mailing Address
First Line	:	1565 W 41ST ST APT 6
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5818
Country	:	US
Telephone Number	:	407-364-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1565 W 41ST ST APT 6
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5818
Country	:	US
Telephone Number	:	407-364-0203
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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