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General NPI Number Information
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NPI Number | 1194728444
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Entity Type | Organization
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Legal Business Name | MONTROSE WELLNESS CENTER PC
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 224 S NEVADA AVE
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City | MONTROSE
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State | CO
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Zip | 81401-4234
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Country | US
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Telephone | 970-252-9644
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Fax | 970-252-9646
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Provider Business Mailing Address
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Address Line | PO BOX 1664
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City | MONTROSE
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State | CO
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Zip | 81402-1664
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Country | US
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Telephone | 970-252-9644
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Fax | 970-252-9646
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Authorized Official
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Title or Position | OWNER
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Name | DR. GAYLE FRAZZETTA
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Credential | MD
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Telephone | 970-252-9644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32730
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License Number State | CO
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