Provider Demographics
NPI:1417071853
Name:MONTALVO, WILNELIA
Entity Type:Individual
Prefix:DR
First Name:WILNELIA
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 CALLE FELIPE LOPEZ
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2248
Mailing Address - Country:US
Mailing Address - Phone:787-413-1040
Mailing Address - Fax:787-890-2281
Practice Address - Street 1:566 CALLE FELIPE LOPEZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2248
Practice Address - Country:US
Practice Address - Phone:787-413-1040
Practice Address - Fax:787-890-2281
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16718208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice