=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871007039
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUKARI DAKTARI CONSULTANTS CSP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2017
-----------------------------------------------------
Last Update Date | 11/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2431 BLVD LUIS A FERRE STE 303
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717-2116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-844-5177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 538
-----------------------------------------------------
City | MERCEDITA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00715-0538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-844-5177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | DR. JOSE A. MONTALVO
-----------------------------------------------------
Credential | MD FACE
-----------------------------------------------------
Telephone | 787-844-5177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 11897
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------