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1265692412 NPI number — MONTALVO NEPHROLOGY INSTITUTE PSC

NPI Number: 1265692412
Health Care Provider/Practitioner: MONTALVO NEPHROLOGY INSTITUTE PSC

Information about “1265692412” NPI (MONTALVO NEPHROLOGY INSTITUTE PSC) exists in 1265692412 in HTML format HTML  |  1265692412 in plain Text format TXT  |  1265692412 in PDF (Portable Document Format) PDF  |  1265692412 in an XML format XML  formats.

NPI Number : 1265692412 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265692412",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MONTALVO NEPHROLOGY INSTITUTE PSC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PMB 274",
    "SecondLineMailingAddress": "PO BOX 6017",
    "MailingAddressCityName": "CAROLINA",
    "MailingAddressStateName": "PR",
    "MailingAddressPostalCode": "00984-6017",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "787-886-3254",
    "MailingAddressFaxNumber": "787-957-1555",
    "FirstLinePracticeLocationAddress": "BI CALLE 1 ALTOS FARMACIA MEDINA 2",
    "SecondLinePracticeLocationAddress": "VILLAS DE LOIZA",
    "PracticeLocationAddressCityName": "CANOVANAS",
    "PracticeLocationAddressStateName": "PR",
    "PracticeLocationAddressPostalCode": "00729-4116",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "787-886-3254",
    "PracticeLocationAddressFaxNumber": "787-957-1555",
    "EnumerationDate": "06/11/2008",
    "LastUpdateDate": "11/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MONTALVO-BURKE",
    "AuthorizedOfficialFirstName": "LISANDRO",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "787-886-3254",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": "13908",
        "LicenseNumberStateCode": "PR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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