Provider Demographics
NPI:1093303117
Name:JUAN MATERON
Entity Type:Organization
Organization Name:JUAN MATERON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY LOU
Authorized Official - Middle Name:A
Authorized Official - Last Name:POSADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-276-3046
Mailing Address - Street 1:11275 E MISSISSIPPI AVE STE 1E3
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2818
Mailing Address - Country:US
Mailing Address - Phone:720-440-2233
Mailing Address - Fax:303-557-6102
Practice Address - Street 1:11275 E MISSISSIPPI AVE STE 1E3
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2818
Practice Address - Country:US
Practice Address - Phone:720-440-2233
Practice Address - Fax:303-557-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental