Provider Demographics
NPI:1053332759
Name:MONTALVO, HECTOR MARIO (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:MARIO
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 KINGMAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6673
Mailing Address - Country:US
Mailing Address - Phone:504-888-3292
Mailing Address - Fax:504-888-3692
Practice Address - Street 1:3020 KINGMAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6673
Practice Address - Country:US
Practice Address - Phone:504-888-3292
Practice Address - Fax:504-888-3692
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11802R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1684398Medicaid
LA1684398Medicaid
LAF85751Medicare UPIN