Basic Information
Provider Information | |||||||||
NPI: | 1871945980 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MONTALVO TOLEDO | ||||||||
FirstName: | LUIS | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 690 CALLE CESAR GONZALEZ | ||||||||
Address2: | COND. PARQUE DE LAS FUENTES APT 2209 | ||||||||
City: | SAN JUAN | ||||||||
State: | PR | ||||||||
PostalCode: | 009183901 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7874056186 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | POLICLINICA DR SALVADOR RIBOT RUIZ | ||||||||
Address2: | CARR 857 KM .4 BO CANOVANILLAS | ||||||||
City: | CAROLINA | ||||||||
State: | PR | ||||||||
PostalCode: | 00987 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877763840 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/13/2016 | ||||||||
LastUpdateDate: | 07/17/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 19815 | PR | Y |   | Allopathic & Osteopathic Physicians | General Practice |   |
No ID Information.