MEDICARE: ALEXANDRA M MONTALVO ACEVEDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	19672	PR
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	19672	PR
3	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	19672	PR

General Provider Information

NPI Number	:	1174938195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA M MONTALVO ACEVEDO MD

Provider Business Mailing Address
First Line	:	140 CALLE VIOLETA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00927-6211
Country	:	US
Telephone Number	:	787-223-5933
Fax Number	:	787-728-7755

Provider Business Practice Location Address
First Line	:	252 CALLE SAN JORGE
Second Line	:	SUITE 307 , EDIF MEDICO SAN JORGE
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3240
Country	:	US
Telephone Number	:	787-233-5933
Fax Number	:	787-728-7755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	10/29/2021

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