Provider Demographics
NPI:1467057067
Name:MONTES DE OCA, MICHEL
Entity Type:Individual
Prefix:MR
First Name:MICHEL
Middle Name:
Last Name:MONTES DE OCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 SW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4615
Mailing Address - Country:US
Mailing Address - Phone:305-273-1247
Mailing Address - Fax:305-273-1272
Practice Address - Street 1:9701 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4615
Practice Address - Country:US
Practice Address - Phone:305-273-1247
Practice Address - Fax:305-273-1272
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist