Provider Demographics
NPI:1588288013
Name:MONTE ALEGRE OLMOS FERNANDEZ, FABIANA (MD)
Entity type:Individual
Prefix:
First Name:FABIANA
Middle Name:
Last Name:MONTE ALEGRE OLMOS FERNANDEZ
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 1:2750 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3586
Mailing Address - Country:US
Mailing Address - Phone:303-440-3268
Mailing Address - Fax:303-440-3179
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3586
Practice Address - Country:US
Practice Address - Phone:303-440-3268
Practice Address - Fax:303-440-3179
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0071153207R00000X
TXT8530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine