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General NPI Number Information
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NPI Number | 1437665064
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Entity Type | Individual
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Provider Name | JORGE J MONTALVO MD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | #125 CALLE CARITE ESQ. AVE. PARANA LOCAL 2 URB. CROWN HILLS, BO. MONACILLO
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-674-4124
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Fax |
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Provider Business Mailing Address
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Address Line | 562 SUMMIT HILLS GREENWOOD
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City | SAN JUAN
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State | PR
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Zip | 00920
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Country | US
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Telephone | 787-674-4124
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 019816
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License Number State | PR
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