Provider Demographics
NPI:1093583858
Name:MONTANEZ ALVARADO, AMANDA GISELLE (RD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GISELLE
Last Name:MONTANEZ ALVARADO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12716 NW 19TH MNR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7759
Mailing Address - Country:US
Mailing Address - Phone:916-740-5485
Mailing Address - Fax:
Practice Address - Street 1:12716 NW 19TH MNR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7759
Practice Address - Country:US
Practice Address - Phone:916-740-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86199289133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered