Provider Demographics
NPI:1083905848
Name:MONTESDEOCA, HOLGER FABRIZIO (MD)
Entity Type:Individual
Prefix:
First Name:HOLGER
Middle Name:FABRIZIO
Last Name:MONTESDEOCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOLGER
Other - Middle Name:FABRIZIO
Other - Last Name:MONTESDEOCA RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5979 VINELAND RD STE 208
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7855
Mailing Address - Country:US
Mailing Address - Phone:407-351-1235
Mailing Address - Fax:407-351-1488
Practice Address - Street 1:3160 SOUTHGATE COMMERCE BLVD STE 34
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8550
Practice Address - Country:US
Practice Address - Phone:407-423-5178
Practice Address - Fax:407-423-5616
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 111820207R00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program