Provider Demographics
NPI:1750838447
Name:OVALLES, MARITZA J
Entity Type:Individual
Prefix:MS
First Name:MARITZA
Middle Name:J
Last Name:OVALLES
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 1:456 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-5126
Mailing Address - Country:US
Mailing Address - Phone:303-504-1769
Mailing Address - Fax:303-733-8239
Practice Address - Street 1:456 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5126
Practice Address - Country:US
Practice Address - Phone:303-504-1769
Practice Address - Fax:303-733-8239
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator