Provider Demographics
NPI:1124296090
Name:REA, MARTHA ELENA (BA)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELENA
Last Name:REA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 S CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1834
Mailing Address - Country:US
Mailing Address - Phone:303-504-1919
Mailing Address - Fax:
Practice Address - Street 1:75 MEADE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-1351
Practice Address - Country:US
Practice Address - Phone:303-504-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator