Provider Demographics
NPI:1437665064
Name:MONTALVO, JORGE J (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:J
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 1:562 SUMMIT HILLS
Mailing Address - Street 2:GREENWOOD
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-674-4124
Mailing Address - Fax:
Practice Address - Street 1:#125 CALLE CARITE ESQ. AVE. PARANA LOCAL 2
Practice Address - Street 2:URB. CROWN HILLS, BO. MONACILLO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-674-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR019816208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice