| |
900 Indiana Ave Suite B Pueblo CO 81004-3767 | |
(719) 924-9128 | |
(719) 924-8053 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 900 Indiana Ave, Pueblo, Colorado |
Authorized Official Name and Position | Anna Mae Martinez (FAMILY NURSE PRACTITIONER) |
Authorized Official Contact | 7199249128 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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900 Indiana Ave Suite B Pueblo CO 81004-3767 Ph: (719) 924-9128 | 900 Indiana Ave Suite B Pueblo CO 81004-3767 Ph: (719) 924-9128 |
NPI Number | 1386082105 |
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Provider Enumeration Date | 06/14/2013 |
Last Update Date | 06/14/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386082105 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 5193 (Colorado) | Primary |
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