Pedro Alfonso Amado Montoya, SA-C

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

21-171 Issued in TN

Practice address

915 Middle River Dr
Fort Lauderdale, FL 33304-3544

Phone

(954) 565-7575

NPI assigned

Mar 13, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1821673609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10637 NW 43RD ST",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333518337",
            "telephone_number": "731-613-8849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 MIDDLE RIVER DR",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333043544",
            "telephone_number": "954-565-7575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "169 Caleb Dr",
            "address_purpose": "LOCATION",
            "city": "Medina",
            "state": "TN",
            "postal_code": "383559735",
            "country_code": "US",
            "telephone_number": "731-613-8849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AMADO MONTOYA",
        "first_name": "PEDRO",
        "middle_name": "ALFONSO",
        "credential": "SA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-13",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "TN",
            "license": "21-171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Assistant in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Surgical Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.