Provider Demographics
NPI:1104034487
Name:MONTOYA, SERGIO (MA)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11373 W FLAGLER ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4203
Mailing Address - Country:US
Mailing Address - Phone:305-226-3214
Mailing Address - Fax:302-226-3264
Practice Address - Street 1:11373 W FLAGLER ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4203
Practice Address - Country:US
Practice Address - Phone:305-226-3214
Practice Address - Fax:302-226-3264
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA36518225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist