Provider Demographics
NPI:1558412627
Name:MONTALVO, LIZZETTE (MD)
Entity Type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:
Last Name:MONTALVO
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:URB RIVER GARDENS
Mailing Address - Street 2:335 CALLE, FLOR DE NONO
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-975-8955
Mailing Address - Fax:787-998-0735
Practice Address - Street 1:335 CALLE FLOR DE NONO
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3356
Practice Address - Country:US
Practice Address - Phone:787-596-3390
Practice Address - Fax:787-998-0735
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20826Medicare ID - Type UnspecifiedPROVIDER NUMBER