Provider Demographics
NPI:1336870690
Name:BACTAD, MONIQUE GAIL DELA CRUZ
Entity Type:Individual
Prefix:
First Name:MONIQUE GAIL
Middle Name:DELA CRUZ
Last Name:BACTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 HORSESHOE FLS
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6911
Mailing Address - Country:US
Mailing Address - Phone:832-316-4510
Mailing Address - Fax:
Practice Address - Street 1:3663 WASHINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-6469
Practice Address - Country:US
Practice Address - Phone:713-426-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician