Provider Demographics
NPI:1700177565
Name:MONTALVO, MARIA LORENA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LORENA
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LORENA
Other - Last Name:MONTALVO MOLINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5130 SUNFOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-310-2214
Practice Address - Street 1:2000 CYPRESS CROSSING DR STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8600
Practice Address - Country:US
Practice Address - Phone:407-515-1507
Practice Address - Fax:727-310-2214
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111872208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist