Basic Information
| Provider Information | |||||||||
| NPI: | 1063609790 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTEALEGRE | ||||||||
| FirstName: | ALVARO | ||||||||
| MiddleName: | IGNACIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6410 FANNIN ST, SUITE 250 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323257131 | ||||||||
| FaxNumber: | 7135122216 | ||||||||
| Practice Location | |||||||||
| Address1: | 6410 FANNIN ST, SUITE 250 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323257131 | ||||||||
| FaxNumber: | 7135122216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2007 | ||||||||
| LastUpdateDate: | 05/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | M7440 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 191668603 | 05 | TX | MEDICAID |