Provider Demographics
NPI:1043568702
Name:MONCIVAIS, VERONICA (MT)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:MONCIVAIS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 W HIGHWAY 83
Mailing Address - Street 2:STE. P
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2530
Mailing Address - Country:US
Mailing Address - Phone:956-787-8255
Mailing Address - Fax:956-782-9977
Practice Address - Street 1:1019 W HIGHWAY 83
Practice Address - Street 2:STE. P
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2530
Practice Address - Country:US
Practice Address - Phone:956-787-8255
Practice Address - Fax:956-782-9977
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT044504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist