Provider Demographics
NPI:1619734613
Name:COLON MONTALVO, MARIA VICTORIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:COLON 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:HC 1 BOX 4500
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9138
Mailing Address - Country:US
Mailing Address - Phone:939-498-6863
Mailing Address - Fax:
Practice Address - Street 1:CARR 14 KM 25.2 INT
Practice Address - Street 2:BO LOS LLANOS
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-9138
Practice Address - Country:US
Practice Address - Phone:939-498-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR164861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical