Provider Demographics
NPI:1699141648
Name:MONTENEGRO, MARTA (MS)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:MONTENEGRO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 SW 73RD ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5151
Mailing Address - Country:US
Mailing Address - Phone:305-663-0588
Mailing Address - Fax:
Practice Address - Street 1:7300 SW 62ND PL
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4806
Practice Address - Country:US
Practice Address - Phone:305-662-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education