Provider Demographics
NPI:1043993447
Name:TOCA MONTERO, LUIS ROLANDO SR
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ROLANDO
Last Name:TOCA MONTERO
Suffix:SR
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 1:3034 W LEROY ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1201
Mailing Address - Country:US
Mailing Address - Phone:813-446-0110
Mailing Address - Fax:
Practice Address - Street 1:7825 N DALE MABRY HWY STE 27
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3272
Practice Address - Country:US
Practice Address - Phone:813-915-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst