Provider Demographics
NPI:1265500557
Name:MONTALVO-COLLINS, MARIA CARMEN
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CARMEN
Last Name:MONTALVO-COLLINS
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 1:24 GWENDOLYN CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-2903
Mailing Address - Country:US
Mailing Address - Phone:919-598-1144
Mailing Address - Fax:919-598-0278
Practice Address - Street 1:24 GWENDOLYN CIR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-2903
Practice Address - Country:US
Practice Address - Phone:919-598-1144
Practice Address - Fax:919-598-0278
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301513Medicaid