Provider Demographics
NPI:1891986600
Name:MONTALVO, ROGELIO F (MD)
Entity type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:F
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:COND PARQUE REALES # 205
Mailing Address - Street 2:30 JUAN DE BORBON
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5316
Mailing Address - Country:US
Mailing Address - Phone:787-406-1408
Mailing Address - Fax:787-474-8211
Practice Address - Street 1:30 CALLE JUAN C BORBON APT 205
Practice Address - Street 2:30 JUAN DE BORBON
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5319
Practice Address - Country:US
Practice Address - Phone:787-406-1408
Practice Address - Fax:787-474-8211
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG 79077Medicare UPIN
PR08-9796Medicare PIN