Provider Demographics
NPI:1548557168
Name:MONTALVO GALIANO, CLARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:CLARY
Middle Name:ANN
Last Name:MONTALVO GALIANO
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 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:1417 LAKELAND HILLS BLVD STE 106
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3200
Practice Address - Country:US
Practice Address - Phone:863-687-4575
Practice Address - Fax:863-582-9335
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-03
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256354207R00000X
PR18419207R00000X
MS26284207R00000X
FLME120978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01380272Medicaid