Provider Demographics
NPI:1558192799
Name:ENRIQUEZ MONTANO, MARIUSKA
Entity type:Individual
Prefix:
First Name:MARIUSKA
Middle Name:
Last Name:ENRIQUEZ MONTANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 BLUE RIBBON LN APT 304
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-2511
Mailing Address - Country:US
Mailing Address - Phone:656-203-1320
Mailing Address - Fax:
Practice Address - Street 1:6504 BLUE RIBBON LN APT 304
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-2511
Practice Address - Country:US
Practice Address - Phone:656-203-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-315820106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician