Provider Demographics
NPI:1396309142
Name:ESPINOSA DE LOS MONTEROS, ANDRES FELIX
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:FELIX
Last Name:ESPINOSA DE LOS MONTEROS
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 1:3030 IRIS CIR
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-5355
Mailing Address - Country:US
Mailing Address - Phone:786-556-3861
Mailing Address - Fax:
Practice Address - Street 1:1701 W FLAGLER ST STE 310
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2099
Practice Address - Country:US
Practice Address - Phone:786-467-7006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-24-73113103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3001Medicaid