Provider Demographics
NPI:1780611004
Name:MONTELONGO, ALEJANDRO (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:
Last Name:MONTELONGO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 REMCON CIR
Mailing Address - Street 2:BLDG A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3514
Mailing Address - Country:US
Mailing Address - Phone:915-581-0357
Mailing Address - Fax:915-584-8313
Practice Address - Street 1:7430 REMCON CIR
Practice Address - Street 2:BLDG A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3514
Practice Address - Country:US
Practice Address - Phone:915-581-0357
Practice Address - Fax:915-584-8313
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N8765OtherBCBS OF TEXAS
TXB164180OtherWELLMED MEDICAL GROUP PA
TXQ38494Medicare UPIN
TX8D8882Medicare ID - Type Unspecified