Provider Demographics
NPI:1760819809
Name:ROMEO F MONTALVO JR MD PA
Entity Type:Organization
Organization Name:ROMEO F MONTALVO JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:F
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-541-8334
Mailing Address - Street 1:864 CENTRAL BLVD
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7551
Mailing Address - Country:US
Mailing Address - Phone:956-541-8334
Mailing Address - Fax:956-541-9738
Practice Address - Street 1:864 CENTRAL BLVD
Practice Address - Street 2:SUITE 2200
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7551
Practice Address - Country:US
Practice Address - Phone:956-541-8334
Practice Address - Fax:956-541-9738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4537208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00HT72OtherBCBS OF TEXAS
TX139506100OtherVALLEY HEALTH PLANS
TX130462805Medicaid
TX130462802Medicaid
2319479OtherAETNA HEALTHCARE
TX116607OtherSUPERIOR HEALTHCARE
TX00HT72OtherBCBS OF TEXAS