MEDICARE: MONTALVO NEPHROLOGY INSTITUTE PSC

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	174400000X	Specialist	13908	PR

General Provider Information

NPI Number	:	1265692412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTALVO NEPHROLOGY INSTITUTE PSC

Provider Business Mailing Address
First Line	:	PMB 274
Second Line	:	PO BOX 6017
City	:	CAROLINA
State	:	PR
Zip	:	00984-6017
Country	:	US
Telephone Number	:	787-886-3254
Fax Number	:	787-957-1555

Provider Business Practice Location Address
First Line	:	BI CALLE 1 ALTOS FARMACIA MEDINA 2
Second Line	:	VILLAS DE LOIZA
City	:	CANOVANAS
State	:	PR
Zip	:	00729-4116
Country	:	US
Telephone Number	:	787-886-3254
Fax Number	:	787-957-1555

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LISANDRO MONTALVO-BURKE
Credential	:	MD
Telephone Number	:	787-886-3254

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	11/17/2025

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