Provider Demographics
NPI:1871798264
Name:MONTALVO, JUAN CARLO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLO
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:L22 CALLE 12
Mailing Address - Street 2:LA QUINTA
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-4117
Mailing Address - Country:US
Mailing Address - Phone:787-267-7554
Mailing Address - Fax:
Practice Address - Street 1:L22 CALLE 12
Practice Address - Street 2:LA QUINTA
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-4117
Practice Address - Country:US
Practice Address - Phone:787-267-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16824208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice