Provider Demographics
NPI:1932411568
Name:MONTALVO, EVARISTO (MD)
Entity type:Individual
Prefix:
First Name:EVARISTO
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8284 SW 179TH TER
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6128
Mailing Address - Country:US
Mailing Address - Phone:305-720-6984
Mailing Address - Fax:
Practice Address - Street 1:8353 SW 124TH ST STE 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-5847
Practice Address - Country:US
Practice Address - Phone:786-250-5607
Practice Address - Fax:786-250-5611
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1211482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology