Provider Demographics
NPI:1821507567
Name:MONTENEGRO, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MONTENEGRO
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 1:13896 SW 143RD ST UNIT I
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7558
Mailing Address - Country:US
Mailing Address - Phone:786-282-6644
Mailing Address - Fax:
Practice Address - Street 1:13896 SW 143RD ST UNIT I
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7558
Practice Address - Country:US
Practice Address - Phone:786-282-6644
Practice Address - Fax:786-282-6644
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician