Provider Demographics
NPI:1194606574
Name:MONTERO, FABIANA COROMOTO
Entity type:Individual
Prefix:
First Name:FABIANA
Middle Name:COROMOTO
Last Name:MONTERO
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 1:3614 GRANDE RESERVE WAY APT 105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4094
Mailing Address - Country:US
Mailing Address - Phone:689-340-6740
Mailing Address - Fax:
Practice Address - Street 1:3614 GRANDE RESERVE WAY APT 105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4094
Practice Address - Country:US
Practice Address - Phone:689-340-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM240-226-35-000-0103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst