Provider Demographics
NPI:1336767037
Name:QUEVEDO MONTERO, AGUSTIN F
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:F
Last Name:QUEVEDO MONTERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 W 18TH CT APT 602
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2843
Mailing Address - Country:US
Mailing Address - Phone:786-368-4675
Mailing Address - Fax:
Practice Address - Street 1:4675 W 18TH CT APT 602
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2843
Practice Address - Country:US
Practice Address - Phone:786-368-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician