Provider Demographics
NPI:1396032389
Name:MARTIN MONTERO, JUANA MARLEN (MD)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:MARLEN
Last Name:MARTIN MONTERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NW 57TH CT
Mailing Address - Street 2:STE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3284
Mailing Address - Country:US
Mailing Address - Phone:786-319-1560
Mailing Address - Fax:
Practice Address - Street 1:11348 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6567
Practice Address - Country:US
Practice Address - Phone:786-319-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA247688207R00000X
PR020163208D00000X
FLME134860208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine