Provider Demographics
NPI:1811041114
Name:CASTRO - MONTALVO, JUSTINIANO (MD)
Entity Type:Individual
Prefix:
First Name:JUSTINIANO
Middle Name:
Last Name:CASTRO - 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 1:425 CARR 693
Mailing Address - Street 2:PMB 371
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4802
Mailing Address - Country:US
Mailing Address - Phone:787-817-4973
Mailing Address - Fax:787-817-4997
Practice Address - Street 1:URB GARCIA CALLE ANDRES GARCIA NO. 53
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-817-4973
Practice Address - Fax:787-817-4997
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10600207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF-51267Medicare UPIN
PR8-3263Medicare ID - Type Unspecified