Healthcare Provider Details

I. General information

NPI: 1861926230
Provider Name (Legal Business Name): FAMILY MEDICINE OF THE ROCKIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 GARDEN DR UNIT 104
AURORA CO
80012-7019
US

IV. Provider business mailing address

10650 GARDEN DR UNIT 104
AURORA CO
80012-7019
US

V. Phone/Fax

Practice location:
  • Phone: 303-369-7752
  • Fax: 303-369-7907
Mailing address:
  • Phone: 303-369-7752
  • Fax: 303-369-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number38896
License Number StateCO

VIII. Authorized Official

Name: MRS. DAHLIA S. CASABAR-FERRER
Title or Position: OWNER
Credential:
Phone: 303-369-7752