Provider Demographics
NPI:1750665527
Name:MONTENEGRO, MARIA CONCEPCION (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CONCEPCION
Last Name:MONTENEGRO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 N LEE TREVINO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4107
Mailing Address - Country:US
Mailing Address - Phone:915-594-1129
Mailing Address - Fax:915-593-6722
Practice Address - Street 1:1831 N LEE TREVINO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4107
Practice Address - Country:US
Practice Address - Phone:915-594-1129
Practice Address - Fax:915-593-6722
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist