Basic Information
| Provider Information | |||||||||
| NPI: | 1548557168 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTALVO GALIANO | ||||||||
| FirstName: | CLARY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 S HARBOUR ISLAND BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336025925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273223439 | ||||||||
| FaxNumber: | 8009287449 | ||||||||
| Practice Location | |||||||||
| Address1: | 1417 LAKELAND HILLS BLVD STE 106 | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338053200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636874575 | ||||||||
| FaxNumber: | 8635829335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2011 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101256354 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 18419 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 26284 | MS | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME120978 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01380272 | 05 | MS | MEDICAID |