Provider Demographics
NPI:1316623846
Name:AMETLLER MONTALVAN, AILER (MD,RBT)
Entity type:Individual
Prefix:
First Name:AILER
Middle Name:
Last Name:AMETLLER MONTALVAN
Suffix:
Gender:F
Credentials:MD,RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3853 NORTHDALE BLVD STE 155
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1861
Mailing Address - Country:US
Mailing Address - Phone:813-418-9038
Mailing Address - Fax:
Practice Address - Street 1:4810 CENTERBROOK CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1039
Practice Address - Country:US
Practice Address - Phone:813-418-9038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-280612106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician