Provider Demographics
NPI:1922585934
Name:MONTALVO MIRO, PAOLA NICOLE (MD, FAAP)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:NICOLE
Last Name:MONTALVO MIRO
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 10 BOX 8496
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-9772
Mailing Address - Country:US
Mailing Address - Phone:787-659-3846
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 22 BARRIO MONACILLOS
Practice Address - Street 2:HOSPITAL PEDIATRICO UNIVERSITARIO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-777-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22518208000000X
PR14764390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program