Healthcare Provider Details

I. General information

NPI: 1255782777
Provider Name (Legal Business Name): MRS. MONIQUE OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIQUE PHILLPOTTS MD

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 4TH AVE
MOLINE IL
61265-1231
US

IV. Provider business mailing address

500 W RIVER DR
DAVENPORT IA
52801-1014
US

V. Phone/Fax

Practice location:
  • Phone: 563-336-3000
  • Fax: 563-327-2045
Mailing address:
  • Phone: 563-336-3000
  • Fax: 563-336-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-10700
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: