Provider Demographics
NPI:1023095791
Name:MYRNA E MONTALVO CASTILLO
Entity type:Organization
Organization Name:MYRNA E MONTALVO CASTILLO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-265-1375
Mailing Address - Street 1:URB. MAYAGUEZ TERRACE 1006 CALLE JOSE E. ARRARAS
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682
Mailing Address - Country:US
Mailing Address - Phone:787-265-1375
Mailing Address - Fax:787-254-9645
Practice Address - Street 1:URB. MAYAGUEZ TERRACE 1006 CALLE JOSE E. ARRARAS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6635
Practice Address - Country:US
Practice Address - Phone:787-265-1375
Practice Address - Fax:787-254-9645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR794291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR003-1462Medicare PIN