Provider Demographics
NPI:1942032974
Name:CARDENAS MONTEAGUDO, MARITZA
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:CARDENAS MONTEAGUDO
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 1:2821 N 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2733
Mailing Address - Country:US
Mailing Address - Phone:954-588-8855
Mailing Address - Fax:
Practice Address - Street 1:2821 N 73RD AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2733
Practice Address - Country:US
Practice Address - Phone:954-588-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician