Provider Demographics
NPI:1912980202
Name:COLTON, DENISE MARIE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:COLTON
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 1:1455 CABLE RANCH RD
Mailing Address - Street 2:APT 714
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2156
Mailing Address - Country:US
Mailing Address - Phone:210-259-8829
Mailing Address - Fax:210-259-8829
Practice Address - Street 1:1455 CABLE RANCH RD
Practice Address - Street 2:APT 714
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2156
Practice Address - Country:US
Practice Address - Phone:210-259-8829
Practice Address - Fax:210-259-8829
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00749356177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging