Healthcare Provider Details

I. General information

NPI: 1760239750
Provider Name (Legal Business Name): LUIS UVALDO SOTELO RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19452 E BRUNSWICK DR
AURORA CO
80013-4736
US

IV. Provider business mailing address

19452 E BRUNSWICK DR
AURORA CO
80013-4736
US

V. Phone/Fax

Practice location:
  • Phone: 720-421-2929
  • Fax:
Mailing address:
  • Phone: 720-421-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberLIC00253093
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: