Healthcare Provider Details

I. General information

NPI: 1871711473
Provider Name (Legal Business Name): LUIS JORGE MONTALVO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 CAMINO DEL MONTE URBANIZACION MIRADERO
HUMACAO PR
00791-9681
US

IV. Provider business mailing address

173 CAMINO DEL MONTE URBANIZACION MIRADERO
HUMACAO PR
00791-9681
US

V. Phone/Fax

Practice location:
  • Phone: 787-597-0083
  • Fax: 787-280-2914
Mailing address:
  • Phone: 787-597-0083
  • Fax: 787-280-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number5204
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: