Provider Demographics
NPI:1306664206
Name:TABARES URREGO, MONICA MARIA (RVT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:MARIA
Last Name:TABARES URREGO
Suffix:
Gender:F
Credentials:RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2731
Mailing Address - Country:US
Mailing Address - Phone:845-248-9398
Mailing Address - Fax:
Practice Address - Street 1:225 ROUTE 10 E
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1300
Practice Address - Country:US
Practice Address - Phone:845-248-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2116202471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography