Provider Demographics
NPI:1053140798
Name:MONTANO RUIZ, MELVY
Entity type:Individual
Prefix:
First Name:MELVY
Middle Name:
Last Name:MONTANO RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25051 SW 130TH AVE APT D301
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4064
Mailing Address - Country:US
Mailing Address - Phone:615-608-8160
Mailing Address - Fax:
Practice Address - Street 1:25051 SW 130TH AVE APT D301
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:FL
Practice Address - Zip Code:33032-4064
Practice Address - Country:US
Practice Address - Phone:615-608-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide