Provider Demographics
NPI:1215644737
Name:MONTALVO, BIANCA CRYSTAL
Entity type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:CRYSTAL
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:PREMONT
Mailing Address - State:TX
Mailing Address - Zip Code:78375-0402
Mailing Address - Country:US
Mailing Address - Phone:361-455-0501
Mailing Address - Fax:
Practice Address - Street 1:351 S SCHOOL RD
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:TX
Practice Address - Zip Code:78071-2724
Practice Address - Country:US
Practice Address - Phone:361-786-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist