Provider Demographics
NPI:1174938195
Name:MONTALVO ACEVEDO, ALEXANDRA M (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:M
Last Name:MONTALVO ACEVEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CALLE VIOLETA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6211
Mailing Address - Country:US
Mailing Address - Phone:787-223-5933
Mailing Address - Fax:787-728-7755
Practice Address - Street 1:252 CALLE SAN JORGE
Practice Address - Street 2:SUITE 307 , EDIF MEDICO SAN JORGE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3240
Practice Address - Country:US
Practice Address - Phone:787-233-5933
Practice Address - Fax:787-728-7755
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19672208000000X, 2084N0402X, 2084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty