Provider Demographics
NPI:1023691508
Name:MONCIVAIS, MANICA
Entity type:Individual
Prefix:
First Name:MANICA
Middle Name:
Last Name:MONCIVAIS
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 1:615 E CANO ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540
Mailing Address - Country:US
Mailing Address - Phone:956-329-1033
Mailing Address - Fax:877-408-9290
Practice Address - Street 1:615 E CANO ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78540
Practice Address - Country:US
Practice Address - Phone:956-329-1033
Practice Address - Fax:877-408-9290
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care