Provider Demographics
NPI:1225322506
Name:MONTEALEGRE, JIMMY JR (RT, CPHT)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:
Last Name:MONTEALEGRE
Suffix:JR
Gender:M
Credentials:RT, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 ANQUILLA AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5297
Mailing Address - Country:US
Mailing Address - Phone:407-616-8803
Mailing Address - Fax:
Practice Address - Street 1:10000 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3400
Practice Address - Country:US
Practice Address - Phone:407-296-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT769183700000X
FLCRT743812471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No183700000XPharmacy Service ProvidersPharmacy Technician