Provider Demographics
NPI:1366634065
Name:MONTANEZ-LEDUC, AMALYS (MD)
Entity Type:Individual
Prefix:
First Name:AMALYS
Middle Name:
Last Name:MONTANEZ-LEDUC
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 1:210 CALLE JACINTO
Mailing Address - Street 2:PRADERAS DE NAVARRO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9032
Mailing Address - Country:US
Mailing Address - Phone:787-981-8707
Mailing Address - Fax:
Practice Address - Street 1:210 CALLE JACINTO
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-9032
Practice Address - Country:US
Practice Address - Phone:787-981-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17437208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17437OtherSTATE MEDICAL LICENCE