Provider Demographics
NPI:1144302373
Name:MONTERO, ADA A (BSMT)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:A
Last Name:MONTERO
Suffix:
Gender:F
Credentials:BSMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12366
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914-0366
Mailing Address - Country:US
Mailing Address - Phone:787-728-5085
Mailing Address - Fax:787-727-5243
Practice Address - Street 1:1964 CALLE LOIZA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1832
Practice Address - Country:US
Practice Address - Phone:787-728-5085
Practice Address - Fax:787-727-5243
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR529291U00000X
PR1605247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38264Medicare PIN