Provider Demographics
NPI:1396241949
Name:MONTES DE OCA, SERGIO DANIEL
Entity type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:DANIEL
Last Name:MONTES DE OCA
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 1:130 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-2404
Mailing Address - Country:US
Mailing Address - Phone:561-762-1615
Mailing Address - Fax:561-855-2398
Practice Address - Street 1:130 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-2404
Practice Address - Country:US
Practice Address - Phone:561-762-1615
Practice Address - Fax:561-855-2398
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLVH4559343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)