Provider Demographics
NPI:1336247600
Name:MONTALVO, DAVID B
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:MONTALVO
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 1:805 AEROVISTA PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7919
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:805 AEROVISTA PL
Practice Address - Street 2:#201
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7919
Practice Address - Country:US
Practice Address - Phone:805-543-7771
Practice Address - Fax:805-543-7761
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OT3741225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT3741AMedicare PIN