Provider Demographics
NPI:1710214226
Name:MONTALVO, XIOMARA (LCDA)
Entity Type:Individual
Prefix:MISS
First Name:XIOMARA
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:LCDA
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 7709
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9643
Mailing Address - Country:US
Mailing Address - Phone:787-517-8042
Mailing Address - Fax:
Practice Address - Street 1:18 CALLE SAN ISIDRO
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1855
Practice Address - Country:US
Practice Address - Phone:787-517-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3130103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4154697OtherELECTORAL IDENTIFICATION