Provider Demographics
NPI:1144273202
Name:MONTOTO, MARIA SUSANA (MS, SLP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SUSANA
Last Name:MONTOTO
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 N.W. 151 STREET
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014
Mailing Address - Country:US
Mailing Address - Phone:305-362-3300
Mailing Address - Fax:305-362-0202
Practice Address - Street 1:5979 N.W. 151 STREET
Practice Address - Street 2:SUITE 108
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-362-3300
Practice Address - Fax:305-362-0202
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890661100Medicaid