Basic Information
Provider Information
NPI: 1891783528
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONTICONE
FirstName: DAVID
MiddleName: EDWARD
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11040 VISTA DEL SOL DR
Address2: STE. A
City: EL PASO
State: TX
PostalCode: 799354304
CountryCode: US
TelephoneNumber: 9155914624
FaxNumber: 9155919291
Practice Location
Address1: 11040 VISTA DEL SOL DR
Address2: STE. A
City: EL PASO
State: TX
PostalCode: 799354304
CountryCode: US
TelephoneNumber: 9155914624
FaxNumber: 9155919291
Other Information
ProviderEnumerationDate: 10/06/2005
LastUpdateDate: 01/19/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XJ2216TXY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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