Provider Demographics
NPI:1366492225
Name:REATEGUI MONTOYA, MELITO (MD)
Entity Type:Individual
Prefix:
First Name:MELITO
Middle Name:
Last Name:REATEGUI MONTOYA
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:CALLE GEORGETTI
Mailing Address - Street 2:#139, SUITE 1
Mailing Address - City:NARANJUO
Mailing Address - State:PR
Mailing Address - Zip Code:00719
Mailing Address - Country:US
Mailing Address - Phone:787-869-6086
Mailing Address - Fax:787-869-6086
Practice Address - Street 1:CALLE GEORGETTI
Practice Address - Street 2:#139, SUITE 1
Practice Address - City:NARANJUO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-6086
Practice Address - Fax:787-869-6086
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16000207Q00000X
PR16.000208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI48155Medicare UPIN
I48155Medicare UPIN
23513Medicare ID - Type Unspecified