=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932411568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVARISTO MONTALVO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2010
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8353 SW 124TH ST STE 208
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-5847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-250-5607
-----------------------------------------------------
Fax | 786-250-5611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8284 SW 179TH TER
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-6128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-720-6984
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | ME121148
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------