Provider Demographics
NPI:1427017102
Name:MONTALVAN - RUIZ, AVELINO (MD)
Entity Type:Individual
Prefix:DR
First Name:AVELINO
Middle Name:
Last Name:MONTALVAN - RUIZ
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:R18 CALLE MARINA
Mailing Address - Street 2:DORADO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2161
Mailing Address - Country:US
Mailing Address - Phone:787-796-0420
Mailing Address - Fax:787-278-0071
Practice Address - Street 1:332B
Practice Address - Street 2:MENDEZ VIGO ST
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-2161
Practice Address - Country:US
Practice Address - Phone:787-796-0420
Practice Address - Fax:787-278-0071
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAM1510735101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77536Medicare UPIN
PR0027440Medicare ID - Type Unspecified