Provider Demographics
NPI:1982670121
Name:MONTALVO, RAUL F (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:F
Last Name: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:PO BOX 801181
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1181
Mailing Address - Country:US
Mailing Address - Phone:787-259-3132
Mailing Address - Fax:787-259-3132
Practice Address - Street 1:JARDINES OF LAFAYETTE
Practice Address - Street 2:A-C-1
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714
Practice Address - Country:US
Practice Address - Phone:787-839-4720
Practice Address - Fax:787-839-1025
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0080167Medicare ID - Type Unspecified
D34263Medicare UPIN