Provider Demographics
NPI:1417030693
Name:MONZON, MIGDALIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MIGDALIA
Middle Name:
Last Name:MONZON
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 1:850 TOWER DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761
Mailing Address - Country:US
Mailing Address - Phone:432-580-0212
Mailing Address - Fax:432-580-0244
Practice Address - Street 1:850 TOWER DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-580-0212
Practice Address - Fax:432-580-0212
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT0111541OtherDPS
TXBM2275178OtherDEA
TXE79290Medicare UPIN