Provider Demographics
NPI:1376639575
Name:MONTALVO, LUIS M (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:M
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:PO BOX 140819
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0819
Mailing Address - Country:US
Mailing Address - Phone:787-878-2758
Mailing Address - Fax:787-817-3531
Practice Address - Street 1:404 DEDIEGO AVE
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-2758
Practice Address - Fax:787-817-3531
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8647207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E83637Medicare UPIN
82398Medicare ID - Type Unspecified