Provider Demographics
NPI:1457865495
Name:MONTES, KARMEN R
Entity Type:Individual
Prefix:
First Name:KARMEN
Middle Name:R
Last Name:MONTES
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 1:1112 PUEBLO BOULEVARD WAY SPC B
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2198
Mailing Address - Country:US
Mailing Address - Phone:719-994-9923
Mailing Address - Fax:
Practice Address - Street 1:1112 PUEBLO BOULEVARD WAY SPC B
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2198
Practice Address - Country:US
Practice Address - Phone:719-994-9923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services