Provider Demographics
NPI:1821877192
Name:MONTERO BERNAL, LOURDES E
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:E
Last Name:MONTERO BERNAL
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 1:16744 SW 99TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3257
Mailing Address - Country:US
Mailing Address - Phone:786-448-3118
Mailing Address - Fax:
Practice Address - Street 1:16744 SW 99TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-3257
Practice Address - Country:US
Practice Address - Phone:786-448-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician