Healthcare Provider Details

I. General information

NPI: 1356587422
Provider Name (Legal Business Name): MONTE CARLO TRADING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 SAGEBRUSH ST
PARKER CO
80138-4230
US

IV. Provider business mailing address

10940 S PARKER RD B-333
PARKER CO
80134-7440
US

V. Phone/Fax

Practice location:
  • Phone: 720-204-1851
  • Fax: 720-851-1962
Mailing address:
  • Phone: 720-204-1851
  • Fax: 720-851-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. PARASKEVI SIDERAKIS
Title or Position: PRESIDENT
Credential:
Phone: 408-472-3215