Provider Demographics
NPI:1811994502
Name:MONSIVAIS, JOSE J (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:MONSIVAIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 GATEWAY BLVD W
Mailing Address - Street 2:SUITE 230
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7618
Mailing Address - Country:US
Mailing Address - Phone:915-590-3666
Mailing Address - Fax:915-590-3667
Practice Address - Street 1:10175 GATEWAY BLVD W
Practice Address - Street 2:SUITE 230
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7618
Practice Address - Country:US
Practice Address - Phone:915-590-3666
Practice Address - Fax:915-590-3667
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9625174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMX3031OtherMEDICAID
TX84T300OtherBLUE CROSS BLUE SHIELD
TX133356906Medicaid
NMX3031OtherMEDICAID
TXD97567Medicare UPIN