Provider Demographics
NPI:1114390291
Name:MONTANO, GRETEL (PTA)
Entity type:Individual
Prefix:
First Name:GRETEL
Middle Name:
Last Name:MONTANO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 W 75TH ST APT 304
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4089
Mailing Address - Country:US
Mailing Address - Phone:786-296-5234
Mailing Address - Fax:
Practice Address - Street 1:7035 NW 173RD DR APT 1608
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4080
Practice Address - Country:US
Practice Address - Phone:786-296-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030505363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology