Provider Demographics
NPI:1871711473
Name:MONTALVO, LUIS JORGE (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:JORGE
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 CAMINO DEL MONTE
Mailing Address - Street 2:URBANIZACION MIRADERO
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9681
Mailing Address - Country:US
Mailing Address - Phone:787-597-0083
Mailing Address - Fax:787-280-2914
Practice Address - Street 1:173 CAMINO DEL MONTE
Practice Address - Street 2:URBANIZACION MIRADERO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-9681
Practice Address - Country:US
Practice Address - Phone:787-597-0083
Practice Address - Fax:787-280-2914
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5204103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80314MOOtherTRIPLE S
PR26095Medicare ID - Type Unspecified
PR80314MOOtherTRIPLE S