Provider Demographics
NPI:1407941750
Name:MOKONCHU, MONIQUE C (MD)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:C
Last Name:MOKONCHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL CENTER DRIVE SUITE 102
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-351-0755
Mailing Address - Fax:915-351-0730
Practice Address - Street 1:1600 MEDICAL CENTER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5002
Practice Address - Country:US
Practice Address - Phone:541-212-9003
Practice Address - Fax:915-533-2568
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4368207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD23693OtherOREGON MEDICAL LICENSE
TXM4368OtherSTATE MEDICAL LICENSE
BM4111960OtherDEA NUMBER