Provider Demographics
NPI:1205872967
Name:MONTALVO, LILLIAN MARIE (MD)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MARIE
Last Name:MONTALVO
Suffix:
Gender:F
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:DEL PARQUE ST. #142
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-725-1100
Mailing Address - Fax:787-725-1200
Practice Address - Street 1:DEL PARQUE ST. #142
Practice Address - Street 2:SUITE #1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911
Practice Address - Country:US
Practice Address - Phone:787-725-1100
Practice Address - Fax:787-725-1200
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13366174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H64880Medicare UPIN