Provider Demographics
NPI:1174637102
Name:PINEIRO MONTALVO, LUIS I (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:I
Last Name:PINEIRO 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:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0409
Mailing Address - Country:US
Mailing Address - Phone:787-851-9361
Mailing Address - Fax:787-264-7291
Practice Address - Street 1:AVE.SANTOS ORTIZ CARR.308 NUM.20
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-0409
Practice Address - Country:US
Practice Address - Phone:787-851-9381
Practice Address - Fax:787-264-7291
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12607261QP2300X
PR012607208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH55694Medicare UPIN
PR89403Medicare ID - Type Unspecified