Provider Demographics
NPI:1891703310
Name:VEGA-MONTALVO, WILFREDO (MD)
Entity Type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:
Last Name:VEGA-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 1:1118 S ORANGE AVENUE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1200
Mailing Address - Country:US
Mailing Address - Phone:407-422-2255
Mailing Address - Fax:407-839-4659
Practice Address - Street 1:1118 S ORANGE AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1200
Practice Address - Country:US
Practice Address - Phone:407-422-2255
Practice Address - Fax:407-839-4659
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079819207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2146Medicare ID - Type Unspecified
FL49724AMedicare ID - Type Unspecified
F61236Medicare UPIN