Provider Demographics
NPI:1710015698
Name:MONTALVO, LUIS A
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:A
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 CARR 102
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-3138
Mailing Address - Country:US
Mailing Address - Phone:787-868-2595
Mailing Address - Fax:787-868-1422
Practice Address - Street 1:153 CALLE COLON
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3061
Practice Address - Country:US
Practice Address - Phone:787-868-2595
Practice Address - Fax:178-786-8142
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4478980001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4478980001Medicare NSC