Basic Information
| Provider Information | |||||||||
| NPI: | 1780611004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTELONGO | ||||||||
| FirstName: | ALEJANDRO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7430 REMCON CIR | ||||||||
| Address2: | BLDG A | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799123514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155810357 | ||||||||
| FaxNumber: | 9155848313 | ||||||||
| Practice Location | |||||||||
| Address1: | 7430 REMCON CIR | ||||||||
| Address2: | BLDG A | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799123514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155810357 | ||||||||
| FaxNumber: | 9155848313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA04532 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 8N8765 | 01 | TX | BCBS OF TEXAS | OTHER | TXB164180 | 01 | WELLMED MEDICAL GROUP PA | OTHER |