Provider Demographics
NPI:1043035710
Name:MONTUFAR-MARTINEZ, AZUCENA
Entity type:Individual
Prefix:
First Name:AZUCENA
Middle Name:
Last Name:MONTUFAR-MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 NATHAN RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-1726
Mailing Address - Country:US
Mailing Address - Phone:404-468-2746
Mailing Address - Fax:
Practice Address - Street 1:142 NATHAN RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-1726
Practice Address - Country:US
Practice Address - Phone:404-468-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter