Doctor Name: | IVELISSE MONTALVO CARRION |
NPI Number: | 1639244551 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 12451 |
Business Practice Address: | Carr 172 Urb Turabo Gardens Hospital San Juan Bautista Caguas, PR - 00725 |
Business Phone Number: | 7877462606 |
Business Fax Number: | |
Mailing Address: | 46 Plaza Cinco, Urb. Gran Vista Ii GURABO |
State: | PR |
Postal Code: | 00778 |
Phone Number: | 7877254403 |
Fax Number: | 7872731849 |
NPI Enumeration Date: | 11/24/2006 |
NPI Last Update Date: | 11/08/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 12451 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |