Provider Demographics
NPI:1558335216
Name:MONZON, FEDERICO ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:ALBERTO
Last Name:MONZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FEDERICO
Other - Middle Name:ALBERTO
Other - Last Name:MONZON-BORDONABA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5008 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5735
Mailing Address - Country:US
Mailing Address - Phone:713-829-7958
Mailing Address - Fax:
Practice Address - Street 1:5008 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5735
Practice Address - Country:US
Practice Address - Phone:713-829-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418604174400000X, 207ZP0007X, 207ZP0102X
TXM8848207ZP0007X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001956529Medicaid
TX8K7025OtherMEDICARE
PA001956529Medicaid
PAH85654Medicare UPIN
H85654Medicare UPIN
TX8K7026Medicare PIN