Provider Demographics
NPI:1427561216
Name:MONCIVAIZ, MELINA (APN)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:MONCIVAIZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MELINA
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 66308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6308
Mailing Address - Country:US
Mailing Address - Phone:832-548-5000
Mailing Address - Fax:713-559-3255
Practice Address - Street 1:4211 WATONGA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-5324
Practice Address - Country:US
Practice Address - Phone:832-548-5000
Practice Address - Fax:281-625-2051
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-016879363LP0200X
TX1016766363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicaid