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General NPI Number Information
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NPI Number | 1548454820
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Entity Type | Individual
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Provider Name | BRYN MONTALVO PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 1255 S WADSWORTH BLVD
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City | LAKEWOOD
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State | CO
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Zip | 80232-5406
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Country | US
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Telephone | 303-985-4832
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Fax | 303-985-4851
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Provider Business Mailing Address
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Address Line | 3701 S BROADWAY
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City | ENGLEWOOD
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State | CO
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Zip | 80113-3611
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Country | US
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Telephone | 303-360-6276
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Fax | 303-467-5355
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MF1392430
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0004495
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License Number State | CO
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