Basic Information
| Provider Information | |||||||||
| NPI: | 1922585934 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTALVO MIRO | ||||||||
| FirstName: | PAOLA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | MD, FAAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 10 BOX 8496 | ||||||||
| Address2: | |||||||||
| City: | SABANA GRANDE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006379772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876593846 | ||||||||
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| Practice Location | |||||||||
| Address1: | CARRETERA 22 BARRIO MONACILLOS | ||||||||
| Address2: | HOSPITAL PEDIATRICO UNIVERSITARIO | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773232 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2018 | ||||||||
| LastUpdateDate: | 03/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 22518 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 390200000X | 14764 | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.