Healthcare Provider Details

I. General information

NPI: 1740322239
Provider Name (Legal Business Name): CENTER FOR HOLISTIC & INTEGRATIVE MEDICINE PROF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14991 E HAMPDEN AVE SUITE 330
AURORA CO
80014-3986
US

IV. Provider business mailing address

14991 E HAMPDEN AVE SUITE 330
AURORA CO
80014-3986
US

V. Phone/Fax

Practice location:
  • Phone: 303-690-9996
  • Fax: 303-400-8450
Mailing address:
  • Phone: 303-690-9996
  • Fax: 303-400-8450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31535
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number31535
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number31535
License Number StateCO

VIII. Authorized Official

Name: RAPHAEL JOSEPH DANGELO
Title or Position: CORPORATE MANAGER
Credential: MD
Phone: 303-690-9996