Healthcare Provider Details

I. General information

NPI: 1407941750
Provider Name (Legal Business Name): MONIQUE C MOKONCHU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER ST SUITE 102
EL PASO TX
79902-5002
US

IV. Provider business mailing address

1600 MEDICAL CENTER DRIVE SUITE 102
EL PASO TX
79902
US

V. Phone/Fax

Practice location:
  • Phone: 541-212-9003
  • Fax: 915-533-2568
Mailing address:
  • Phone: 915-351-0755
  • Fax: 915-351-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberM4368
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberM4368
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: