Healthcare Provider Details

I. General information

NPI: 1194728444
Provider Name (Legal Business Name): MONTROSE WELLNESS CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S NEVADA AVE
MONTROSE CO
81401-4234
US

IV. Provider business mailing address

PO BOX 1664
MONTROSE CO
81402-1664
US

V. Phone/Fax

Practice location:
  • Phone: 970-252-9644
  • Fax: 970-252-9646
Mailing address:
  • Phone: 970-252-9644
  • Fax: 970-252-9646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32730
License Number StateCO

VIII. Authorized Official

Name: DR. GAYLE FRAZZETTA
Title or Position: OWNER
Credential: MD
Phone: 970-252-9644