Healthcare Provider Details

I. General information

NPI: 1083521173
Provider Name (Legal Business Name): EDDIE GIOVANNI MONTALVO VELAZQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CALLE SAN ROBERTO
SAN JUAN PR
00926-2731
US

IV. Provider business mailing address

131 CALLE ALAMO
LAJAS PR
00667-2502
US

V. Phone/Fax

Practice location:
  • Phone: 787-773-6501
  • Fax: 787-773-6544
Mailing address:
  • Phone: 787-354-0972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: