Healthcare Provider Details

I. General information

NPI: 1922585934
Provider Name (Legal Business Name): PAOLA NICOLE MONTALVO MIRO MD, FAAP,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 22 BARRIO MONACILLOS HOSPITAL PEDIATRICO UNIVERSITARIO
SAN JUAN PR
00919
US

IV. Provider business mailing address

HC 10 BOX 8496
SABANA GRANDE PR
00637-9772
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3232
  • Fax:
Mailing address:
  • Phone: 787-659-3846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22518
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number14764
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number22518
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: