Healthcare Provider Details

I. General information

NPI: 1689584658
Provider Name (Legal Business Name): MARTINA ITA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 E PRENTICE AVE STE B2
GREENWOOD VILLAGE CO
80111-2726
US

IV. Provider business mailing address

545 LINDENWOOD CT
HIGHLANDS RANCH CO
80126-2711
US

V. Phone/Fax

Practice location:
  • Phone: 970-946-8737
  • Fax:
Mailing address:
  • Phone: 402-937-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number24523636
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009927315
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: