Provider Demographics
NPI:1932142064
Name:MONSERRATE, PEDRO (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:MONSERRATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 CLEVELAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7182
Mailing Address - Country:US
Mailing Address - Phone:239-574-0011
Mailing Address - Fax:239-574-4020
Practice Address - Street 1:2721 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 260
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5781
Practice Address - Country:US
Practice Address - Phone:239-574-0011
Practice Address - Fax:239-574-4020
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063174174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0599674OtherGHI PPO
FL373039500Medicaid
FL3911740004OtherCIGNA HMO
FL18915OtherBCBS
FL592207264OtherCIGNA PPO
FL592207264EOtherHUMANA
FL4374392OtherAETNA PPO
FL0905525OtherUHC
FL0664623OtherAETNA HMO
FL373039500Medicaid
FLE31518Medicare UPIN
FL0626040002Medicare NSC
FL0599674OtherGHI PPO
FL0905525OtherUHC