MEDICARE: DR. WALDO SANTIAGO MONTALVO M.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
1	207RG0100X	Gastroenterology Physician	10425	PR

General Provider Information

NPI Number	:	1386624716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALDO SANTIAGO MONTALVO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 633
Second Line	:
City	:	CABO ROJO
State	:	PR
Zip	:	00623-0633
Country	:	US
Telephone Number	:	787-882-2929
Fax Number	:	787-819-0130

Provider Business Practice Location Address
First Line	:	23 CALLE SEVERIANO CUEVAS
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00603-5713
Country	:	US
Telephone Number	:	787-882-2929
Fax Number	:	787-882-2929

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	10/24/2016

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