Healthcare Provider Details

I. General information

NPI: 1295934081
Provider Name (Legal Business Name): DOREEN TELISAK MARINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOREEN ANN TELISAK M.D.

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S POTOMAC ST SUITE 110
AURORA CO
80012-4528
US

IV. Provider business mailing address

1400 S POTOMAC ST SUITE 110
AURORA CO
80012-4528
US

V. Phone/Fax

Practice location:
  • Phone: 303-745-0000
  • Fax: 303-745-1299
Mailing address:
  • Phone: 303-745-0000
  • Fax: 303-745-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA113085
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45811
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: