1497031462 NPI number — MR. EDDY MONTALVAN LMT

Table of content: MR. EDDY MONTALVAN LMT (NPI 1497031462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497031462 NPI number — MR. EDDY MONTALVAN LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTALVAN
Provider First Name:
EDDY
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497031462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18210 MEDITERRANEAN BLVD
Provider Second Line Business Mailing Address:
APT 2004
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33015-5759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-721-8296
Provider Business Mailing Address Fax Number:
305-384-4835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18210 MEDITERRANEAN BLVD
Provider Second Line Business Practice Location Address:
APT 2004
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33015-5759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-721-8296
Provider Business Practice Location Address Fax Number:
305-384-4835
Provider Enumeration Date:
10/22/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  50925 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)