Provider Demographics
NPI:1487634937
Name:CANO MONTOYA, ANGELICA MARIA (MD)
Entity Type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:MARIA
Last Name:CANO 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 1:1877 FORTUNE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4428
Mailing Address - Country:US
Mailing Address - Phone:407-943-8600
Mailing Address - Fax:407-932-5140
Practice Address - Street 1:109 N DOVERPLUM AVENUE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3475
Practice Address - Country:US
Practice Address - Phone:407-943-8600
Practice Address - Fax:407-943-8640
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13120174400000X
FLME138976208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13120OtherSTATE LICENSE
FL011959700Medicaid