1932142064 NPI number — PEDRO MONSERRATE M.D.

Table of content: PEDRO MONSERRATE M.D. (NPI 1932142064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932142064 NPI number — PEDRO MONSERRATE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONSERRATE
Provider First Name:
PEDRO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932142064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3210 CLEVELAND AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33901-7182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-574-0011
Provider Business Mailing Address Fax Number:
239-574-4020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2721 DEL PRADO BLVD S
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33904-5781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-574-0011
Provider Business Practice Location Address Fax Number:
239-574-4020
Provider Enumeration Date:
06/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME0063174 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0599674 . This is a "GHI PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 373039500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3911740004 . This is a "CIGNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 18915 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 592207264 . This is a "CIGNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 592207264E . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4374392 . This is a "AETNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0905525 . This is a "UHC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0664623 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".