Provider Demographics
NPI:1477591451
Name:MONTOYA, MARIBEL (MD)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:MONTOYA
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 1:213 S DILLARD ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3522
Mailing Address - Country:US
Mailing Address - Phone:407-409-8067
Mailing Address - Fax:407-409-8068
Practice Address - Street 1:213 S DILLARD ST
Practice Address - Street 2:SUITE 240
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3522
Practice Address - Country:US
Practice Address - Phone:407-409-8067
Practice Address - Fax:407-409-8068
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84429174400000X
FLME 84429207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
773114OtherMAILHANDLERS
695956OtherTUFTS
7194953OtherMAMSI
593516436002OtherTRICARE
FL28028OtherBCBS OF FLORIDA
593516436OtherMEDICAL MUTUAL
FLP00397536OtherRR GBA PALMETTO
695956OtherTUFTS
FLP00397536OtherRR GBA PALMETTO