Healthcare Provider Details

I. General information

NPI: 1346791340
Provider Name (Legal Business Name): CDT DOCTORES MONTALVO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 CALLE GAUTIER BENITEZ
ARECIBO PR
00612-4418
US

IV. Provider business mailing address

PO BOX 846
ARECIBO PR
00613-0846
US

V. Phone/Fax

Practice location:
  • Phone: 787-880-1020
  • Fax: 787-879-4441
Mailing address:
  • Phone: 787-880-1020
  • Fax: 787-879-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS N MONTALVO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-880-1020