Provider Demographics
NPI:1538235247
Name:ASENCIO-MONTALVO, MADELINE A (MD)
Entity type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:A
Last Name:ASENCIO-MONTALVO
Suffix:
Gender:F
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:BOX 8
Mailing Address - Street 2:CALLE CARBONELL 56
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-851-3965
Mailing Address - Fax:787-851-3965
Practice Address - Street 1:CALLE CARBONELL 56
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-3965
Practice Address - Fax:787-851-3965
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10274207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F94454Medicare UPIN
83322Medicare ID - Type Unspecified