Healthcare Provider Details

I. General information

NPI: 1063335750
Provider Name (Legal Business Name): JESICA LUMARY SEDA MONTALVO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARQUE INDUSTRIAL DEL OESTE CALLE ROCHELAISE 29
MAYAGUEZ PR
00682
US

IV. Provider business mailing address

C2 E7 URB MARGARITA
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-904-9131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number6912
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: