Provider Demographics
NPI:1194742676
Name:PROANO, MARITZA (MD)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:PROANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N GRAND AVE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2760
Mailing Address - Country:US
Mailing Address - Phone:719-543-3500
Mailing Address - Fax:719-543-3504
Practice Address - Street 1:1600 N GRAND AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2760
Practice Address - Country:US
Practice Address - Phone:719-543-3500
Practice Address - Fax:719-543-3504
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10153207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13702Medicaid
NDN711788Medicare PIN
E58629Medicare UPIN
ND13702Medicaid