Provider Demographics
NPI:1881761195
Name:MONTALVO, LISANDRO (MD)
Entity type:Individual
Prefix:DR
First Name:LISANDRO
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:12 CALLE REINA ISABEL
Mailing Address - Street 2:URB. LA VILLA DE TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3278
Mailing Address - Country:US
Mailing Address - Phone:787-764-4536
Mailing Address - Fax:787-754-8322
Practice Address - Street 1:512A CALLE JUAN J JIMENEZ
Practice Address - Street 2:URB. PARQUE CENTRAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2605
Practice Address - Country:US
Practice Address - Phone:787-764-4942
Practice Address - Fax:787-731-9198
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR4202207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC83938Medicare UPIN