Healthcare Provider Details

I. General information

NPI: 1639980667
Provider Name (Legal Business Name): MONTANA DENEEN OROZCO CRM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 E JEFFERSON ST
STAYTON OR
97383-1855
US

IV. Provider business mailing address

PO BOX 17818
SALEM OR
97305-7818
US

V. Phone/Fax

Practice location:
  • Phone: 971-273-8303
  • Fax:
Mailing address:
  • Phone: 503-363-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: