Healthcare Provider Details

I. General information

NPI: 1558066019
Provider Name (Legal Business Name): TAMARY ANGELIZ SOLIS MONTALVO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. INDUSTRIAL LAS FLORES, CARR. 3, KM. 23.9
RIO GRANDE PR
00721
US

IV. Provider business mailing address

D 153 CALLE 3 URB ALTURAS DE RIO GRANDE
RIO GRANDE PR
00745
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-0705
  • Fax:
Mailing address:
  • Phone: 787-325-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16315
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: