Provider Demographics
NPI:1699245639
Name:MONTANE, IRENE ANGELICA
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:ANGELICA
Last Name:MONTANE
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 1:27242 SW 164TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031-2802
Mailing Address - Country:US
Mailing Address - Phone:305-815-5650
Mailing Address - Fax:
Practice Address - Street 1:27242 SW 164TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33031-2802
Practice Address - Country:US
Practice Address - Phone:305-815-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant