Provider Demographics
NPI:1316837115
Name:MENCHACA, MARTHA ERICA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ERICA
Last Name:MENCHACA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:SILT
Mailing Address - State:CO
Mailing Address - Zip Code:81652-8781
Mailing Address - Country:US
Mailing Address - Phone:970-948-2981
Mailing Address - Fax:
Practice Address - Street 1:1430 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:SILT
Practice Address - State:CO
Practice Address - Zip Code:81652-8781
Practice Address - Country:US
Practice Address - Phone:970-948-2981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program