Healthcare Provider Details

I. General information

NPI: 1225558265
Provider Name (Legal Business Name): MARTHA L MONTEMAYOR CNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 E COLFAX AVE
DENVER CO
80220-1301
US

IV. Provider business mailing address

5105 E COLFAX AVE
DENVER CO
80220-1301
US

V. Phone/Fax

Practice location:
  • Phone: 720-443-2420
  • Fax: 720-302-0138
Mailing address:
  • Phone: 303-618-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: