Healthcare Provider Details

I. General information

NPI: 1427017102
Provider Name (Legal Business Name): AVELINO MONTALVAN - RUIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332B MENDEZ VIGO ST
DORADO PR
00646-2161
US

IV. Provider business mailing address

R18 CALLE MARINA DORADO DEL MAR
DORADO PR
00646-2161
US

V. Phone/Fax

Practice location:
  • Phone: 787-796-0420
  • Fax: 787-278-0071
Mailing address:
  • Phone: 787-796-0420
  • Fax: 787-278-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAM1510735
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: