1356817662 NPI number — MONICA MARIE OROZCO CANTILLO APRN

Table of content: MONICA MARIE OROZCO CANTILLO APRN (NPI 1356817662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356817662 NPI number — MONICA MARIE OROZCO CANTILLO APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OROZCO CANTILLO
Provider First Name:
MONICA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

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:
1356817662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12920 SW 108 PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33176-1435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-404-1599
Provider Business Mailing Address Fax Number:
443-456-4211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12651 S DIXIE HWY STE 311
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINECREST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33156-5961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-404-1599
Provider Business Practice Location Address Fax Number:
443-456-4211
Provider Enumeration Date:
10/15/2018

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: 207Q00000X , with the licence number:  9263561 , 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)





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