Provider Demographics
NPI:1679540454
Name:AFANADOR MONTALVO, WILFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:AFANADOR 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:PO BOX 931
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0931
Mailing Address - Country:US
Mailing Address - Phone:787-735-7215
Mailing Address - Fax:787-735-1804
Practice Address - Street 1:51 CALLE GERONIMO MARTINEZ
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3661
Practice Address - Country:US
Practice Address - Phone:787-735-7215
Practice Address - Fax:787-735-1804
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12072208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H546905Medicare UPIN