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General NPI Number Information
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NPI Number | 1104436617
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Entity Type | Individual
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Provider Name | LUIS MONCADA
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Gender | Male
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 1150 N LOOP 1604 W STE 150
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City | SAN ANTONIO
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State | TX
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Zip | 78248-4505
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Country | US
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Telephone | 281-783-8162
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Fax |
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Provider Business Mailing Address
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Address Line | 5718 WESTHEIMER RD STE 400
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City | HOUSTON
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State | TX
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Zip | 77057-5733
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Country | US
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Telephone | 281-783-8162
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15818
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License Number State | TX
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