Provider Demographics
NPI:1316902299
Name:MONTANEZ, VICTOR M (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:MONTANEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:MARTINEZ MONTANEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 8208
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8208
Mailing Address - Country:US
Mailing Address - Phone:787-515-8869
Mailing Address - Fax:787-785-1829
Practice Address - Street 1:STATE PSYCHIATRIC HOSPITAL,
Practice Address - Street 2:CALLE MAGA, BO. MONACILLO, CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-766-4646
Practice Address - Fax:787-296-2409
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14887208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9560121OtherHUMANA HEALTH PLAN
PR2-2120MOOtherTRILPE-S HEALTHCARE PLAN
PR2011106OtherPREFERRED HEALTHCRE PLAN
PR0022120Medicare ID - Type UnspecifiedPROVIDER NUMBER