Provider Demographics
NPI:1487048468
Name:CLINICA HERNANDEZ Y MONTALVO, LLC.
Entity type:Organization
Organization Name:CLINICA HERNANDEZ Y MONTALVO, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-310-8890
Mailing Address - Street 1:11-16 CARR 174
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6609
Mailing Address - Country:US
Mailing Address - Phone:787-510-7400
Mailing Address - Fax:
Practice Address - Street 1:11-16 CARR 174
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6609
Practice Address - Country:US
Practice Address - Phone:787-510-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PW5498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty