Provider Demographics
NPI:1336464320
Name:MONTALVO, MANUEL ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ALBERTO
Last Name: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 1:10-19 CALLE 3
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6612
Mailing Address - Country:US
Mailing Address - Phone:787-779-2501
Mailing Address - Fax:
Practice Address - Street 1:10-19 CALLE 3
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6612
Practice Address - Country:US
Practice Address - Phone:787-779-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17809172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker