Provider Demographics
NPI:1780236299
Name:MELITO REATEGUI MONTOYA LLC
Entity type:Organization
Organization Name:MELITO REATEGUI MONTOYA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELITO
Authorized Official - Middle Name:
Authorized Official - Last Name:REATEGUI MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-869-6086
Mailing Address - Street 1:139 CALLE GEORGETTI STE 1
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-3022
Mailing Address - Country:US
Mailing Address - Phone:787-869-6086
Mailing Address - Fax:787-693-0544
Practice Address - Street 1:139 CALLE GEORGETTI STE 1
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3022
Practice Address - Country:US
Practice Address - Phone:787-869-6086
Practice Address - Fax:787-693-0544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MELITO REATEGUI MONTOYA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty