Provider Demographics
NPI:1710093075
Name:CLEMENTE-ORTIZ, MONICA M (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:CLEMENTE-ORTIZ
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 1:6101 WEBB RD STE 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2865
Mailing Address - Country:US
Mailing Address - Phone:813-610-9031
Mailing Address - Fax:877-868-5943
Practice Address - Street 1:780 4TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4412
Practice Address - Country:US
Practice Address - Phone:727-502-0052
Practice Address - Fax:727-502-0057
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN708208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN708OtherMEDICAL LICENSE NUMBER
FLACN708OtherMEDICAL LICENSE NUMBER