Healthcare Provider Details

I. General information

NPI: 1114363330
Provider Name (Legal Business Name): ZALINA MONTOYA-BACA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 E EXPOSITION AVE STE 320
DENVER CO
80209-5033
US

IV. Provider business mailing address

4805 MOORHEAD AVE
BOULDER CO
80305-5520
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-1151
  • Fax: 303-777-3112
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: