Healthcare Provider Details

I. General information

NPI: 1942439047
Provider Name (Legal Business Name): SARA MONTANEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 10/23/2022
Certification Date: 10/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 E FLORIDA AVE STE 200
DENVER CO
80222-3641
US

IV. Provider business mailing address

4105 E FLORIDA AVE
DENVER CO
80222-3620
US

V. Phone/Fax

Practice location:
  • Phone: 303-539-0736
  • Fax: 303-539-0737
Mailing address:
  • Phone: 303-539-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: