Provider Demographics
NPI:1073228011
Name:MONT, ELBA IRIS
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:IRIS
Last Name:MONT
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:PO BOX 141715
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1715
Mailing Address - Country:US
Mailing Address - Phone:787-941-1817
Mailing Address - Fax:
Practice Address - Street 1:53 CALLE ANDRES GARCIA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4392
Practice Address - Country:US
Practice Address - Phone:787-816-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR193363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical