Healthcare Provider Details

I. General information

NPI: 1861792293
Provider Name (Legal Business Name): EDELMIRO MONTALVO-CABAN C.M.T., C.L.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCLEARY ST. 1752 SUITE 4
SAN JUAN PR
00911
US

IV. Provider business mailing address

CALLE 1A-24 PARQUES DE SAN IGNACIO
SAN JUAN PR
00921-4848
US

V. Phone/Fax

Practice location:
  • Phone: 787-562-3774
  • Fax:
Mailing address:
  • Phone: 787-562-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: