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NPI Code Detail

MEDICARE: MONIQUE GAIL DELA CRUZ BACTAD

MEDICARE: MONIQUE GAIL DELA CRUZ BACTAD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183700000XPharmacy Technician

General Provider Information

NPI Number : 1336870690
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONIQUE GAIL DELA CRUZ BACTAD
Provider Business Mailing Address
First Line : 5651 HORSESHOE FLS
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77459-6911
Country : US
Telephone Number : 832-316-4510
Fax Number :
Provider Business Practice Location Address
First Line : 3663 WASHINGTON AVE STE 100
Second Line :
City : HOUSTON
State : TX
Zip : 77007-6469
Country : US
Telephone Number : 713-426-1961
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2022
Last Update Date : 06/17/2022

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Directions to “ MONIQUE GAIL DELA CRUZ BACTAD ” Practice Location

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