Healthcare Provider Details

I. General information

NPI: 1952547127
Provider Name (Legal Business Name): OCCMED COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 B CHAMBERS ROAD
AURORA CO
80011
US

IV. Provider business mailing address

550 E THORNTON PARKWAY SUITE 110
THORNTON CO
80229
US

V. Phone/Fax

Practice location:
  • Phone: 720-859-6139
  • Fax:
Mailing address:
  • Phone: 720-872-0399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number33333
License Number StateCO

VIII. Authorized Official

Name: MONIKA LISA VALENTINE
Title or Position: EXECUTIVE
Credential:
Phone: 720-872-0399