Provider Demographics
NPI:1326025073
Name:MONTALVO, MYRNA (MT)
Entity Type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 COLS DE ALTURAS
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-6272
Mailing Address - Country:US
Mailing Address - Phone:787-265-1375
Mailing Address - Fax:787-265-1375
Practice Address - Street 1:1088 JOSE ARRARAS STE 2
Practice Address - Street 2:MAYAGUEZ TERRACE
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6601
Practice Address - Country:US
Practice Address - Phone:787-265-1375
Practice Address - Fax:787-265-1375
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5217246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR003-1462Medicare PIN