Organization
JESUS MONTESANO MD LLC
Active
Other names
Jesus Montesano MD PA
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH N DE VERA (RA)
(786) 200-8305
Entity
Organization
Contact information
Practice address
664 E 25TH ST, SUITE 101, HIALEAH, FL 33013-3805
(305) 835-7625
(305) 835-0550
Mailing address
1000 NW 57TH CT STE 400, MIAMI, FL 33126-3292
(305) 649-8100
(305) 835-0550
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
ME 57047
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064494300
—
FL
Enumeration date
10/22/2012
Last updated
05/08/2023
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