Provider Demographics
NPI:1225558265
Name:MONTEMAYOR, MARTHA L (CNC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:MONTEMAYOR
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1301
Mailing Address - Country:US
Mailing Address - Phone:303-618-1774
Mailing Address - Fax:
Practice Address - Street 1:5101 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1301
Practice Address - Country:US
Practice Address - Phone:720-443-2420
Practice Address - Fax:720-302-0138
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist