MEDICARE: PAOLA MARIE MONTALVO VIDRO

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	103TC1900X	Counseling Psychologist	8793	PR

General Provider Information

NPI Number	:	1629935671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLA MARIE MONTALVO VIDRO

Provider Business Mailing Address
First Line	:	HC 1 BOX 10765
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-9751
Country	:	US
Telephone Number	:	939-381-0134
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 CALLE 7
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-5405
Country	:	US
Telephone Number	:	939-381-0134
Fax Number	:

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

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	03/04/2026

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