Provider Demographics
NPI:1679609101
Name:MONTPEROUS, ELSIE (ITDS)
Entity type:Individual
Prefix:
First Name:ELSIE
Middle Name:
Last Name:MONTPEROUS
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SW 191ST TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6095
Mailing Address - Country:US
Mailing Address - Phone:305-336-1178
Mailing Address - Fax:954-441-5184
Practice Address - Street 1:1001 SW 191ST TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-6095
Practice Address - Country:US
Practice Address - Phone:305-336-1178
Practice Address - Fax:954-441-5184
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)