Provider Demographics
NPI:1902679715
Name:MONCAYO, XAVIER ALFONSO (COMT)
Entity Type:Individual
Prefix:
First Name:XAVIER
Middle Name:ALFONSO
Last Name:MONCAYO
Suffix:
Gender:M
Credentials:COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3577 SHADY PINES ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-6907
Mailing Address - Country:US
Mailing Address - Phone:202-603-9450
Mailing Address - Fax:
Practice Address - Street 1:8328 SHOPPERS SQ
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-2174
Practice Address - Country:US
Practice Address - Phone:703-420-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD144731156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic