Provider Demographics
NPI:1710220884
Name:MONTANEZ, VIRGINIA (LPN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO. JACABOA SECTOR MERLE
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-0000
Mailing Address - Country:US
Mailing Address - Phone:939-630-0136
Mailing Address - Fax:787-271-0004
Practice Address - Street 1:99 GUILLERMO RIEFKHOL STREET
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723-0000
Practice Address - Country:US
Practice Address - Phone:787-839-4320
Practice Address - Fax:787-271-0004
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR30729164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse