Provider Demographics
NPI:1821292525
Name:LOPEZ-MONTALVO, MARITZA (MD)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:LOPEZ-MONTALVO
Suffix:
Gender:F
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:PO BOX 5103
Mailing Address - Street 2:PMB 305
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-5103
Mailing Address - Country:US
Mailing Address - Phone:787-314-9418
Mailing Address - Fax:787-265-2229
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:COND SAN VICENTE, SUITE 211
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1554
Practice Address - Country:US
Practice Address - Phone:787-843-5420
Practice Address - Fax:787-848-5287
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14870208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14870OtherSTATE LICENSE NUMBER