Provider Demographics
NPI:1548565492
Name:MONTOYA, CLEO ANNA
Entity Type:Individual
Prefix:MRS
First Name:CLEO
Middle Name:ANNA
Last Name:MONTOYA
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:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:MANASSA
Mailing Address - State:CO
Mailing Address - Zip Code:81141-0404
Mailing Address - Country:US
Mailing Address - Phone:719-580-2757
Mailing Address - Fax:
Practice Address - Street 1:311 SOUTH 6TH STREET
Practice Address - Street 2:
Practice Address - City:MANASSA
Practice Address - State:CO
Practice Address - Zip Code:81141-0404
Practice Address - Country:US
Practice Address - Phone:719-580-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7765171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications