Provider Demographics
NPI:1013283779
Name:MONTENEGRO, DANIEL ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ENRIQUE
Last Name:MONTENEGRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 NE 164TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4018
Mailing Address - Country:US
Mailing Address - Phone:305-947-0027
Mailing Address - Fax:305-945-8734
Practice Address - Street 1:1701 NE 164TH ST STE 200
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4018
Practice Address - Country:US
Practice Address - Phone:305-947-0027
Practice Address - Fax:305-945-8734
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142618207W00000X, 207W00000X
OK31999207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program