Provider Demographics
NPI:1972572782
Name:MONTALVO BONILLA, CARLOS N
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:N
Last Name:MONTALVO BONILLA
Suffix:
Gender:M
Credentials:
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 846
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0846
Mailing Address - Country:US
Mailing Address - Phone:787-880-1020
Mailing Address - Fax:787-880-1011
Practice Address - Street 1:51 CALLE GAUTIER BENITEZ
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4418
Practice Address - Country:US
Practice Address - Phone:787-880-1020
Practice Address - Fax:787-880-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6372207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1319OtherPMC
PRC82751Medicare UPIN
PR1319OtherPMC