Provider Demographics
NPI:1548771462
Name:MARTIN MONTEJO, OSVALDO ORGELIO
Entity Type:Individual
Prefix:
First Name:OSVALDO
Middle Name:ORGELIO
Last Name:MARTIN MONTEJO
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 1:3933 SW KAMSLER ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4046
Mailing Address - Country:US
Mailing Address - Phone:772-626-5108
Mailing Address - Fax:
Practice Address - Street 1:3933 SW KAMSLER ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4046
Practice Address - Country:US
Practice Address - Phone:772-626-5108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health