Provider Demographics
NPI:1417154576
Name:MONTES DE OCA, MARTHA LUCIA (LMT 50396)
Entity Type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:LUCIA
Last Name:MONTES DE OCA
Suffix:
Gender:M
Credentials:LMT 50396
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 W 61ST ST
Mailing Address - Street 2:APT 206
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5980
Mailing Address - Country:US
Mailing Address - Phone:305-820-8587
Mailing Address - Fax:
Practice Address - Street 1:2740 W 61ST ST
Practice Address - Street 2:APT 206
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5980
Practice Address - Country:US
Practice Address - Phone:305-820-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50396225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist