Provider Demographics
NPI:1548333875
Name:MONTILLA-FULLANA, VICTOR JOSE (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:JOSE
Last Name:MONTILLA-FULLANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RO-13 URB. RIACHUELO
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6140
Mailing Address - Country:US
Mailing Address - Phone:787-760-7093
Mailing Address - Fax:
Practice Address - Street 1:RO-13 URB. RIACHUELO
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6140
Practice Address - Country:US
Practice Address - Phone:787-760-7093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8801208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine