Provider Demographics
NPI:1639187081
Name:MARTIN, MONIQUE EVA
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:EVA
Last Name:MARTIN
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 1:499 W BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-6701
Mailing Address - Country:US
Mailing Address - Phone:303-762-7206
Mailing Address - Fax:303-762-7207
Practice Address - Street 1:499 W BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-6701
Practice Address - Country:US
Practice Address - Phone:303-762-7206
Practice Address - Fax:303-762-7207
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine