Healthcare Provider Details

I. General information

NPI: 1124406103
Provider Name (Legal Business Name): ADA M MONTALVO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

10131 W MILITARY DR STE 104
SAN ANTONIO TX
78251-1927
US

V. Phone/Fax

Practice location:
  • Phone: 832-524-5000
  • Fax:
Mailing address:
  • Phone: 210-899-1450
  • Fax: 210-899-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10001
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: