Provider Demographics
NPI:1881438398
Name:ABREU MONTANO, MAURO A
Entity type:Individual
Prefix:
First Name:MAURO
Middle Name:A
Last Name:ABREU MONTANO
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 1:1300 PONCE DE LEON BLVD APT 704
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3359
Mailing Address - Country:US
Mailing Address - Phone:786-580-7159
Mailing Address - Fax:
Practice Address - Street 1:1300 PONCE DE LEON BLVD APT 704
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3359
Practice Address - Country:US
Practice Address - Phone:786-580-7159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-346191106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty