Healthcare Provider Details

I. General information

NPI: 1992202881
Provider Name (Legal Business Name): ERROR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 RALSTON RD STE 204
ARVADA CO
80002-2249
US

IV. Provider business mailing address

PO BOX 29037
THORNTON CO
80229-0037
US

V. Phone/Fax

Practice location:
  • Phone: 303-209-7590
  • Fax: 303-208-7590
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMAR G PATEL
Title or Position: CEO
Credential: MD
Phone: 562-536-8422