Provider Demographics
NPI:1336627827
Name:PRIETO, MONICA (CCHW)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:PRIETO
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S DILLARD ST STE 340
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3596
Mailing Address - Country:US
Mailing Address - Phone:407-656-6938
Mailing Address - Fax:844-560-2349
Practice Address - Street 1:213 S DILLARD ST STE 340
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3596
Practice Address - Country:US
Practice Address - Phone:407-656-6938
Practice Address - Fax:844-560-2349
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
FL172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No374J00000XNursing Service Related ProvidersDoula