MEDICARE: DENISE MARIE COLTON

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	177F00000X	Lodging Provider	00749356	LA

General Provider Information

NPI Number	:	1912980202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE MARIE COLTON

Provider Business Mailing Address
First Line	:	1455 CABLE RANCH RD
Second Line	:	APT 714
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-2156
Country	:	US
Telephone Number	:	210-259-8829
Fax Number	:	210-259-8829

Provider Business Practice Location Address
First Line	:	1455 CABLE RANCH RD
Second Line	:	APT 714
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-2156
Country	:	US
Telephone Number	:	210-259-8829
Fax Number	:	210-259-8829

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/08/2007

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