Provider Demographics
NPI:1336399849
Name:MONCAYO, CESAR ENRIQUE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:CESAR
Middle Name:ENRIQUE
Last Name:MONCAYO
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 METRIC BLVD APT 1320
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3318
Mailing Address - Country:US
Mailing Address - Phone:512-670-3110
Mailing Address - Fax:
Practice Address - Street 1:13401 METRIC BLVD APT 1320
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-3318
Practice Address - Country:US
Practice Address - Phone:512-670-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT006521225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist