Provider Demographics
NPI:1265692412
Name:MONTALVO NEPHROLOGY INSTITUTE PSC
Entity type:Organization
Organization Name:MONTALVO NEPHROLOGY INSTITUTE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTALVO-BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-886-3254
Mailing Address - Street 1:PMB 274
Mailing Address - Street 2:PO BOX 6017
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-6017
Mailing Address - Country:US
Mailing Address - Phone:787-886-3254
Mailing Address - Fax:787-957-1555
Practice Address - Street 1:BI CALLE 1 ALTOS FARMACIA MEDINA 2
Practice Address - Street 2:VILLAS DE LOIZA
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-4116
Practice Address - Country:US
Practice Address - Phone:787-886-3254
Practice Address - Fax:787-957-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I45045Medicare UPIN