Provider Demographics
NPI:1841062916
Name:CONTRERAS, MONIQUE L (CARE GIVING SUPPORT)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:L
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:CARE GIVING SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 SILVER PLUME DR
Mailing Address - Street 2:
Mailing Address - City:BATTLEMENT MESA
Mailing Address - State:CO
Mailing Address - Zip Code:81635-9011
Mailing Address - Country:US
Mailing Address - Phone:970-836-4343
Mailing Address - Fax:
Practice Address - Street 1:84 SILVER PLUME DR
Practice Address - Street 2:
Practice Address - City:BATTLEMENT MESA
Practice Address - State:CO
Practice Address - Zip Code:81635-9011
Practice Address - Country:US
Practice Address - Phone:970-836-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171M00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93-4828635Medicaid
CO172V00000XMedicaid