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NPI Code Detail

MEDICARE: DR. BRENDA LIZ QUINTANA MONTALVO PSY.D.

MEDICARE: DR. BRENDA LIZ QUINTANA MONTALVO PSY.D.
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
1103TC0700XClinical Psychologist5707PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15707OTHERPRPSYCHOLOGIST

General Provider Information

NPI Number : 1356893788
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRENDA LIZ QUINTANA MONTALVO PSY.D.
Provider Business Mailing Address
First Line : PO BOX 1100
Second Line :
City : SAN SEBASTIAN
State : PR
Zip : 00685-1100
Country : US
Telephone Number : 787-400-7078
Fax Number :
Provider Business Practice Location Address
First Line : 66 CALLE MJ CABRERO
Second Line :
City : SAN SEBASTIAN
State : PR
Zip : 00685-4843
Country : US
Telephone Number : 787-955-0270
Fax Number : 787-955-0270
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2016
Last Update Date : 07/30/2024

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