Healthcare Provider Details

I. General information

NPI: 1750580122
Provider Name (Legal Business Name): JOCELYN MONTALVO ORTIZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA GATSBY SUITE 318 CALLE PADIAL # 30
CAGUAS PR
00739
US

IV. Provider business mailing address

URB SABANERA CAMINO DE LA LOMA 224
CIDRA PR
00739
US

V. Phone/Fax

Practice location:
  • Phone: 787-436-2288
  • Fax: 952-213-4356
Mailing address:
  • Phone: 787-436-2288
  • Fax: 952-213-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17569
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number17569
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: