Provider Demographics
NPI:1003162363
Name:MONTESINO, GENDRY
Entity Type:Individual
Prefix:
First Name:GENDRY
Middle Name:
Last Name:MONTESINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3373 W 90TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2005
Mailing Address - Country:US
Mailing Address - Phone:786-442-5424
Mailing Address - Fax:
Practice Address - Street 1:3373 W 90TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-2005
Practice Address - Country:US
Practice Address - Phone:786-442-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst