Provider Demographics
NPI:1316399546
Name:SANTIAGO MONTALVO, CRISTINE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINE
Middle Name:MARIE
Last Name:SANTIAGO MONTALVO
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 1:1668 W PEACE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-5332
Mailing Address - Country:US
Mailing Address - Phone:601-859-5213
Mailing Address - Fax:
Practice Address - Street 1:840 MERCY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7820
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:407-905-8998
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21196208000000X
FLME143677208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics