Provider Demographics
NPI:1477138220
Name:MONTERO, MISAEL
Entity Type:Individual
Prefix:
First Name:MISAEL
Middle Name:
Last Name:MONTERO
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 1:2229 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2040
Mailing Address - Country:US
Mailing Address - Phone:305-266-2929
Mailing Address - Fax:786-377-5525
Practice Address - Street 1:2229 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2040
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:786-377-5525
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006578363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner