Provider Demographics
NPI:1699466177
Name:MONTEJO, REINALDO RENE
Entity type:Individual
Prefix:
First Name:REINALDO
Middle Name:RENE
Last Name:MONTEJO
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 1:707 NW 111TH CT APT 10
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3785
Mailing Address - Country:US
Mailing Address - Phone:786-498-0770
Mailing Address - Fax:
Practice Address - Street 1:707 NW 111TH CT APT 10
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3785
Practice Address - Country:US
Practice Address - Phone:786-498-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB910699106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician