Provider Demographics
NPI:1376311639
Name:AMANDA MONTANEZ LLC
Entity Type:Organization
Organization Name:AMANDA MONTANEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:GISELLE
Authorized Official - Last Name:MONTANEZ ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:916-740-5485
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093583858OtherPERSONAL NPI NUMBER