Healthcare Provider Details

I. General information

NPI: 1699603035
Provider Name (Legal Business Name): ALEXIS MIGUEL MONROY PORTILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH STREET STOP 9410
LUBBOCK TX
79430
US

IV. Provider business mailing address

2ND STREET 36-75 ZONE 7 PARQUE MATEO BUILDING APARTMENT A805 ACCESS CODE 5075
GUATEMALA CITY GUATEMALA
01007
GT

V. Phone/Fax

Practice location:
  • Phone: 806-743-6840
  • Fax: 806-743-3143
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: