Provider Demographics
NPI:1548454820
Name:MONTALVO, BRYN (PA-C)
Entity type:Individual
Prefix:MS
First Name:BRYN
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRYN
Other - Middle Name:
Other - Last Name:FURLONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3701 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3611
Mailing Address - Country:US
Mailing Address - Phone:303-360-6276
Mailing Address - Fax:303-467-5355
Practice Address - Street 1:1255 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5406
Practice Address - Country:US
Practice Address - Phone:303-985-4832
Practice Address - Fax:303-985-4851
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMF1392430363AM0700X
COPA.0004495363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical