Provider Demographics
NPI:1770085706
Name:MONTES SANTANA, JOSE A (RMHCI, CBHCMS)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:MONTES SANTANA
Suffix:
Gender:M
Credentials:RMHCI, CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19010 NW 44TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2630
Mailing Address - Country:US
Mailing Address - Phone:786-208-9094
Mailing Address - Fax:
Practice Address - Street 1:2131 HOLLYWOOD BLVD STE 401
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6775
Practice Address - Country:US
Practice Address - Phone:954-366-9888
Practice Address - Fax:305-422-9029
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100924171M00000X
FLIMH25011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106349100Medicaid