Provider Demographics
NPI:1285931154
Name:MONTEAGUDO, ENRIQUE (MT)
Entity type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:MONTEAGUDO
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 SW 133RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:434 SW 12TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2440
Practice Address - Country:US
Practice Address - Phone:305-642-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61568225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist