1821292525 NPI number — MARITZA LOPEZ-MONTALVO M.D.

Table of content: MARITZA LOPEZ-MONTALVO M.D. (NPI 1821292525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821292525 NPI number — MARITZA LOPEZ-MONTALVO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ-MONTALVO
Provider First Name:
MARITZA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1821292525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5103
Provider Second Line Business Mailing Address:
PMB 305
Provider Business Mailing Address City Name:
CABO ROJO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00623-5103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-314-9418
Provider Business Mailing Address Fax Number:
787-265-2229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8169 CALLE CONCORDIA
Provider Second Line Business Practice Location Address:
COND SAN VICENTE, SUITE 211
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-843-5420
Provider Business Practice Location Address Fax Number:
787-848-5287
Provider Enumeration Date:
06/14/2007

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: 208100000X , with the licence number:  14870 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14870 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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