Provider Demographics
NPI:1245765486
Name:ELSTON, MONTERRIO JAJUAN SR
Entity Type:Individual
Prefix:PROF
First Name:MONTERRIO
Middle Name:JAJUAN
Last Name:ELSTON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 MERRILL DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4009
Mailing Address - Country:US
Mailing Address - Phone:501-663-2209
Mailing Address - Fax:501-663-2234
Practice Address - Street 1:1719 MERRILL DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4009
Practice Address - Country:US
Practice Address - Phone:501-663-2209
Practice Address - Fax:501-663-2234
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator