Healthcare Provider Details

I. General information

NPI: 1619324951
Provider Name (Legal Business Name): LYSVETTE MONTALVO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CALLE ZUZUARREGUI
MARICAO PR
00606
US

IV. Provider business mailing address

A4 EXTENCION LA CONCEPCION
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-838-3057
  • Fax:
Mailing address:
  • Phone: 787-538-3796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6030
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: