Healthcare Provider Details

I. General information

NPI: 1306040423
Provider Name (Legal Business Name): LUIS F MONTANER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 AVE FD ROOSEVELT THIRD FLOOR (HUMANA)
SAN JUAN PR
00918-2131
US

IV. Provider business mailing address

PO BOX 6091 LOIZA STATION
SAN JUAN PR
00914-6091
US

V. Phone/Fax

Practice location:
  • Phone: 787-622-5886
  • Fax:
Mailing address:
  • Phone: 787-791-4792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2418
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: