1346712049 NPI number — MR. MANUEL ALEJANDRO MONTALVAN RODRIGUEZ APRN

Table of content: MR. MANUEL ALEJANDRO MONTALVAN RODRIGUEZ APRN (NPI 1346712049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346712049 NPI number — MR. MANUEL ALEJANDRO MONTALVAN RODRIGUEZ APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTALVAN RODRIGUEZ
Provider First Name:
MANUEL
Provider Middle Name:
ALEJANDRO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTALVAN
Provider Other First Name:
MANUEL
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346712049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1023 US HIGHWAY 27 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33825-5107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-201-7329
Provider Business Mailing Address Fax Number:
863-201-7251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1023 US HIGHWAY 27 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33825-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-383-1818
Provider Business Practice Location Address Fax Number:
770-691-5064
Provider Enumeration Date:
12/19/2018

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: 363LF0000X , with the licence number:  11000504 , 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)





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