Provider Demographics
NPI:1831329390
Name:MONTANEZ, MELISSA (RD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 TWIN SABAL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2529
Mailing Address - Country:US
Mailing Address - Phone:305-495-3280
Mailing Address - Fax:
Practice Address - Street 1:7400 TWIN SABAL DR
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2529
Practice Address - Country:US
Practice Address - Phone:305-495-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-19
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5214133V00000X
FL00960564133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered