Provider Demographics
NPI:1457352825
Name:MONTEMAYOR, ROSA A (DPM)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:A
Last Name:MONTEMAYOR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9255 W ALAMEDA AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2802
Mailing Address - Country:US
Mailing Address - Phone:303-233-9107
Mailing Address - Fax:303-233-1534
Practice Address - Street 1:9255 W ALAMEDA AVE
Practice Address - Street 2:SUITE F
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2802
Practice Address - Country:US
Practice Address - Phone:303-233-9107
Practice Address - Fax:303-233-1534
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO396213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01003961Medicaid
CO40258OtherBCBS PROVIDER NUMBER
CO83306021Medicaid
CO841090662OtherTAX ID
CO83306021Medicaid
CO003518Medicare ID - Type UnspecifiedELECTRONIC MEDICARE
COT60340Medicare UPIN
CO40258OtherBCBS PROVIDER NUMBER
CO480003825Medicare ID - Type UnspecifiedRAILROAD MEDICARE