Provider Demographics
NPI:1689719619
Name:ROSA MONTEMAYOR DPM PC
Entity Type:Organization
Organization Name:ROSA MONTEMAYOR DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEMAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-233-9107
Mailing Address - Street 1:9255 W ALAMEDA AVE STE F
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2802
Mailing Address - Country:US
Mailing Address - Phone:303-233-9107
Mailing Address - Fax:303-233-1534
Practice Address - Street 1:9255 W ALAMEDA AVE STE F
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2802
Practice Address - Country:US
Practice Address - Phone:303-233-9107
Practice Address - Fax:303-233-1534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO396213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01003961Medicaid
CO40258OtherBCBS ID NUMBER
CO83306021Medicaid
COCO03006Medicare ID - Type UnspecifiedSUBMITTER ID
CO40258OtherBCBS ID NUMBER
CO83306021Medicaid
COC528068Medicare PIN