Healthcare Provider Details

I. General information

NPI: 1013978873
Provider Name (Legal Business Name): KIMBERLY ANN MOURANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 E ILIFF AVE STE 210
AURORA CO
80014-1405
US

IV. Provider business mailing address

14001 E ILIFF AVE STE 210
AURORA CO
80014-1405
US

V. Phone/Fax

Practice location:
  • Phone: 303-996-9601
  • Fax: 303-369-2605
Mailing address:
  • Phone: 303-996-9601
  • Fax: 303-369-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35990
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: