Provider Demographics
NPI:1316010184
Name:MONTALVO LORENZO, DOLCA (MD)
Entity Type:Individual
Prefix:
First Name:DOLCA
Middle Name:
Last Name:MONTALVO LORENZO
Suffix:
Gender:F
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 367
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0367
Mailing Address - Country:US
Mailing Address - Phone:787-826-2607
Mailing Address - Fax:787-826-2607
Practice Address - Street 1:CALLE 65 DE INFANTERIA #51
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-0367
Practice Address - Country:US
Practice Address - Phone:787-826-2607
Practice Address - Fax:787-826-2607
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7987208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0029666Medicare ID - Type Unspecified
G40277Medicare UPIN