Provider Demographics
NPI:1194713172
Name:MONTALVO, ANDRES (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDRES
Other - Middle Name:
Other - Last Name:MONTALVO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:RR 2 BOX 9
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9767
Mailing Address - Country:US
Mailing Address - Phone:787-748-9252
Mailing Address - Fax:
Practice Address - Street 1:2521 13TH ST STE D
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4103
Practice Address - Country:US
Practice Address - Phone:407-734-1273
Practice Address - Fax:866-738-7531
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN5572084P0800X
PR67222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR066966OtherPSYCHIATRIST
FL010942000Medicaid
PR80211Medicare PIN
PR066966OtherPSYCHIATRIST