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General NPI Number Information
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NPI Number | 1336209063
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Entity Type | Individual
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Provider Name | LISANDRO MONTALVO BURKE
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | BI CALLE 1 ALTOS FARMACIA MEDINA 2 VILLAS DE LOIZA
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City | CANOVANAS
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State | PR
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Zip | 00729-4116
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Country | US
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Telephone | 787-886-3254
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Fax | 787-957-1555
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Provider Business Mailing Address
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Address Line | PO BOX 274
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City | CAROLINA
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State | PR
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Zip | 00986-0274
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Country | US
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Telephone | 787-886-3254
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Fax | 787-957-1555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 13908
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License Number State | PR
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