MEDICARE: MONTANA DENEEN OROZCO CRM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1639980667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONTANA DENEEN OROZCO CRM

Provider Business Mailing Address
First Line	:	PO BOX 17818
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-7818
Country	:	US
Telephone Number	:	503-363-2021
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 E JEFFERSON ST
Second Line	:
City	:	STAYTON
State	:	OR
Zip	:	97383-1855
Country	:	US
Telephone Number	:	971-273-8303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2025
Last Update Date	:	01/17/2025

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Directions to “ MONTANA DENEEN OROZCO CRM” Practice Location

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