Provider Demographics
NPI:1518639459
Name:MONTANES, NAILET
Entity Type:Individual
Prefix:MRS
First Name:NAILET
Middle Name:
Last Name:MONTANES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18816 NW 52ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2371
Mailing Address - Country:US
Mailing Address - Phone:305-824-7598
Mailing Address - Fax:
Practice Address - Street 1:18816 NW 52ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2371
Practice Address - Country:US
Practice Address - Phone:305-824-7598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB482979106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician