Provider Demographics
NPI:1245520543
Name:LONG, MONICA SILVA (CHES)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:SILVA
Last Name:LONG
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-1228
Mailing Address - Country:US
Mailing Address - Phone:915-587-7176
Mailing Address - Fax:
Practice Address - Street 1:306 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-1228
Practice Address - Country:US
Practice Address - Phone:915-587-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16122174H00000X, 390200000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No251S00000XAgenciesCommunity/Behavioral Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program