Provider Demographics
NPI:1588404693
Name:BYERS-BLAKE, MARLINA (SPECIALIST)
Entity type:Individual
Prefix:
First Name:MARLINA
Middle Name:
Last Name:BYERS-BLAKE
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:MARLINA
Other - Middle Name:
Other - Last Name:BYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 S COLORADO BLVD BLDG 1-2000
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7910
Mailing Address - Country:US
Mailing Address - Phone:303-900-8962
Mailing Address - Fax:
Practice Address - Street 1:PHENIX SALON SUITES 119/121
Practice Address - Street 2:8501 W BOWLES AVE
Practice Address - City:LITTLETON
Practice Address - State:CA
Practice Address - Zip Code:80123
Practice Address - Country:US
Practice Address - Phone:303-900-8962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCOS.07172571744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management