MEDICARE: JOSE J. MONSIVAIS M.D.

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
1	174400000X	Specialist	G9625	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	84T300	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811994502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE J. MONSIVAIS M.D.

Provider Business Mailing Address
First Line	:	10175 GATEWAY BLVD W
Second Line	:	SUITE 230
City	:	EL PASO
State	:	TX
Zip	:	79925-7618
Country	:	US
Telephone Number	:	915-590-3666
Fax Number	:	915-590-3667

Provider Business Practice Location Address
First Line	:	10175 GATEWAY BLVD W
Second Line	:	SUITE 230
City	:	EL PASO
State	:	TX
Zip	:	79925-7618
Country	:	US
Telephone Number	:	915-590-3666
Fax Number	:	915-590-3667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/10/2010

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Directions to “ JOSE J. MONSIVAIS M.D.” Practice Location

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